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St Thomas More Medical Complex

Details

Type of Ownership For profit - Corporation
Participates in Medicare? Yes
Participates in Medicaid? Yes
Certified Beds 250
Continuing Care? No
Resident Council? Yes
Family Council? No
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: 03/14/2012

Date of last standard health inspection: 03/14/2012
Quality Indicator Survey No
Dates of Complaint Investigations: 04/01/2011 - 03/31/2012
Total number of Health Deficiencies for this nursing home: 2
Average number of Health Deficiencies in MD: 4
Average number of Health Deficiencies in US: 3
Range of Health Deficiencies in MD: 0 - 19
Quality Care Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Provide necessary care and services to maintain or improve the highest well being of each resident. 02/09/2012 00/02/2002 2 Few
Resident Assessment Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Make sure that doctors see a resident's plan of care at every visit and make notes about progress and orders in writing. 02/09/2012 00/02/2002 2 Few

Inspection, 01/05/2011

Administration Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Operate and provide services according to Federal, State, and local laws and professional standards. 01/05/2011 00/08/2001 2 Few
Choose a doctor to serve as the medical director to create resident care policies and coordinate medical care in the facility. 01/05/2011 00/08/2001 2 Many
Quickly tell the resident's doctor the results of laboratory tests. 01/05/2011 00/08/2001 4 Few
Keep accurate, complete and organized clinical records on each resident that meet professional standards. 01/05/2011 00/08/2001 2 Some
Set up an ongoing quality assessment and assurance group to review quality deficiencies quarterly, and develop corrective plans of action. 01/05/2011 00/08/2001 2 Few
Keep accurate 01/05/2011 00/08/2001 Some complete and organized clinical records on each re
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. 01/05/2011 00/08/2001 2 Few
Have a program that investigates, controls and keeps infection from spreading. 01/05/2011 00/08/2001 2 Few
Be designed, built, equipped, or well kept to protect the health and safety of residents, workers, and the public. 01/05/2011 00/08/2001 2 Few
Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. 01/05/2011 00/08/2001 2 Few
Have a program that investigates 01/05/2011 00/08/2001 Few controls and keeps infection from spreading.
Be designed 01/05/2011 00/08/2001 equipped built
Nutrition and Dietary Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Store 01/05/2011 00/08/2001 and serve food in a safe and clean way. cook
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. 01/05/2011 00/08/2001 4 Many
Maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards. 01/05/2011 00/08/2001 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. 01/05/2011 00/08/2001 4 Many
Maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards. 01/05/2011 00/08/2001 2 Some
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. 01/05/2011 02/03/2001 2 Few
Provide necessary care and services to maintain or improve the highest well being of each resident. 01/05/2011 00/08/2001 3 Few
Assist those residents who need help with eating/drinking, grooming and personal and oral hygiene. 01/05/2011 00/08/2001 2 Few
Ensure residents maintain acceptable nutritional status. 01/05/2011 00/08/2001 2 Some
Give each resident enough fluids to keep them healthy and prevent dehydration. 01/05/2011 00/08/2001 2 Few
Provide care by qualified persons according to each resident's written plan of care. 01/05/2011 00/08/2001 2 Few
Provide necessary care and services to maintain or improve the highest well being of each resident. 01/05/2011 00/08/2001 3 Few
Assist those residents who need help with eating/drinking 01/05/2011 00/08/2001 Few grooming and personal and oral hygiene.
Ensure residents maintain acceptable nutritional status. 01/05/2011 00/08/2001 2 Some
Resident Assessment Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Conduct initial and periodic assessments of each resident's functional capacity. 01/05/2011 00/08/2001 2 Few
Allow residents the right to participate in the planning or revision of care and treatment. 01/05/2011 00/08/2001 2 Few
Make sure that doctors see a resident's plan of care at every visit and make notes about progress and orders in writing. 01/05/2011 00/08/2001 2 Some
Develop a complete care plan that meets all the resident's needs 01/05/2011 00/08/2001 Some with timetables and actions that can be measured.
Allow residents the right to participate in the planning or revision of care and treatment. 01/05/2011 00/08/2001 2 Few
Resident Rights Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. 01/05/2011 00/08/2001 2 Some

Inspection, 01/09/2010

Administration Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Operate and provide services according to Federal 01/09/2010 01/05/2011 and local laws and professional standards. State
Give or get quality laboratory services/tests in a timely manner to meet the needs of residents. 01/09/2010 01/05/2011 2 Few
Keep accurate 01/09/2010 01/05/2011 Few complete and organized clinical records on each re
Environmental Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Provide housekeeping and maintenance services. 01/09/2010 01/05/2011 2 Few
Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. 01/09/2010 01/05/2011 2 Few
Have a program that investigates 01/09/2010 01/05/2011 Some controls and keeps infection from spreading.
Keep all essential equipment working safely. 01/09/2010 01/05/2011 2 Many
Mistreatment Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Keep each resident free from drugs that restrain them 01/09/2010 01/05/2011 Few unless needed for medical treatment.
Nutrition and Dietary Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Store 01/09/2010 01/05/2011 and serve food in a safe and clean way. cook
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. 01/09/2010 01/05/2011 2 Few
Keep the rate of medication errors (wrong drug 01/09/2010 01/05/2011 wrong time) to less than 5%. wrong dose
At least once a month 01/09/2010 01/05/2011 Few have a licensed pharmacist review each resident's
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. 01/09/2010 01/05/2011 2 Few
Provide necessary care and services to maintain or improve the highest well being of each resident. 01/09/2010 01/05/2011 2 Few
Ensure that residents receive proper treatment and assistive devices to maintain their vision and hearing. 01/09/2010 01/05/2011 2 Few
Ensure that each resident who enters the nursing home without a catheter is not given a catheter 01/09/2010 01/05/2011 and that incontinent patients receive proper servi unless medically necessary
Provide or obtain dental services for each resident. 01/09/2010 01/05/2011 2 Few
Resident Assessment Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Conduct initial and periodic assessments of each resident's functional capacity. 01/09/2010 01/05/2011 2 Some
Develop a complete care plan that meets all the resident's needs 01/09/2010 01/05/2011 Some with timetables and actions that can be measured.
Allow residents the right to participate in the planning or revision of care and treatment. 01/09/2010 01/05/2011 2 Few
Resident Rights Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Let residents refuse treatment 01/09/2010 01/05/2011 or formulate advance directives. refuse to take part in an experiment
Give residents a notice of rights 01/09/2010 01/05/2011 services and charges. rules
Immediately tell the resident 01/09/2010 01/05/2011 and a family member of situations (injury/decline/ the resident's doctor
Properly hold 01/09/2010 01/05/2011 and manage each resident's personal money which is secure
Keep residents' personal and medical records private and confidential. 01/09/2010 01/05/2011 2 Few
Provide care for residents in a way that maintains or improves their dignity and respect in full recognition of their individuality. 01/09/2010 01/05/2011 2 Few
Immediately tell the resident 01/09/2010 00/08/2011 and a family member of situations (injury/decline/ the resident's doctor

Inspection, 02/00/2008

Environmental Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Provide enough power supply for lighting all entrances and exits; equipment for fire detection and alarm systems 02/00/2008 01/07/2009 Many and extinguishers.

Inspection, 01/04/2008

Administration Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Keep accurate 01/04/2008 01/07/2009 Few complete and organized clinical records on each re
Mistreatment Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
1) Hire only people with no legal history of abusing 01/04/2008 01/07/2009 neglect or mistreatment of residents. neglecting or mistreating residents; or 2) report
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. 01/04/2008 01/07/2009 2 Few
Provide necessary care and services to maintain or improve the highest well being of each resident. 01/04/2008 01/07/2009 3 Few
Resident Assessment Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Develop a complete care plan that meets all the resident's needs 01/04/2008 01/07/2009 Few with timetables and actions that can be measured.
Make sure that doctors see a resident's plan of care at every visit and make notes about progress and orders in writing. 01/04/2008 01/07/2009 2 Few

Inspection, 02/01/2007

Administration Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Quickly tell the resident's doctor the results of laboratory tests. 02/01/2007 01/09/2008 2 Few
Quickly tell the resident's doctor the results of laboratory tests. 02/01/2007 01/09/2008 2 Few
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. 02/01/2007 01/09/2008 2 Few
Keep all essential equipment working safely. 02/01/2007 01/09/2008 2 Few
Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. 02/01/2007 01/09/2008 2 Few
Keep all essential equipment working safely. 02/01/2007 01/09/2008 2 Few
Resident Assessment Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. 02/01/2007 01/09/2008 2 Few
Allow residents the right to participate in the planning or revision of care and treatment. 02/01/2007 01/09/2008 2 Few
Develop a complete care plan that meets all the resident's needs 02/01/2007 01/09/2008 Few with timetables and actions that can be measured.
Allow residents the right to participate in the planning or revision of care and treatment. 02/01/2007 01/09/2008 2 Few

Inspection, 00/02/2006

Quality Care Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Provide necessary care and services to maintain or improve the highest well being of each resident. 00/02/2006 01/07/2007 2 Few
Resident Rights Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Let residents refuse treatment 00/02/2006 01/07/2007 or formulate advance directives. refuse to take part in an experiment

Inspection, 00/02/2004

Administration Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Operate and provide services according to Federal 00/02/2004 01/00/2006 and local laws and professional standards. State

Inspection, 01/06/2003

Administration Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Keep accurate 01/06/2003 00/07/2006 Few complete and organized clinical records on each re
Mistreatment Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
1) Hire only people with no legal history of abusing 01/06/2003 00/07/2006 neglect or mistreatment of residents. neglecting or mistreating residents; or 2) report
Resident Rights Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Immediately tell the resident 01/06/2003 00/07/2006 and a family member of situations (injury/decline/ the resident's doctor

Inspection, 01/04/2003

Administration Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Set up an ongoing quality assessment and assurance group to review quality deficiencies quarterly, and develop corrective plans of action. 01/04/2003 01/02/2004 2 Few
Set up an ongoing quality assessment and assurance group to review quality deficiencies quarterly 01/04/2003 01/02/2004 Few and develop corrective plans of action.
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. 01/04/2003 01/02/2004 2 Few
At least once a month, have a licensed pharmacist review each resident's medication(s) and report any irregularities to the attending doctor. 01/04/2003 01/02/2004 2 Few
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. 01/04/2003 01/02/2004 2 Few
At least once a month 01/04/2003 01/02/2004 Few have a licensed pharmacist review each resident's
Resident Assessment Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. 01/04/2003 01/02/2004 2 Few
Develop a complete care plan that meets all the resident's needs 01/04/2003 01/02/2004 Few with timetables and actions that can be measured.

Inspection, 02/06/2001

Administration Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Keep accurate 02/06/2001 01/06/2002 Few complete and organized clinical records on each re
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. 02/06/2001 02/05/2010 4 Few
Mistreatment Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
1) Hire only people with no legal history of abusing 02/06/2001 01/06/2002 neglect or mistreatment of residents. neglecting or mistreating residents; or 2) report
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. 02/06/2001 01/06/2002 2 Few
At least once a month 02/06/2001 01/06/2002 Few have a licensed pharmacist review each resident's
Quality Care Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Provide necessary care and services to maintain or improve the highest well being of each resident. 02/06/2001 01/06/2002 2 Few
Ensure that each resident who enters the nursing home without a catheter is not given a catheter 02/06/2001 01/06/2002 and that incontinent patients receive proper servi unless medically necessary
Resident Assessment Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Ensure each resident receives an accurate assessment by a qualified health professional. 02/06/2001 01/06/2002 2 Few
Develop a complete care plan that meets all the resident's needs 02/06/2001 01/06/2002 Few with timetables and actions that can be measured.
Make sure that doctors see a resident's plan of care at every visit and make notes about progress and orders in writing. 02/06/2001 01/06/2002 2 Few
Resident Rights Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Immediately tell the resident 02/06/2001 01/06/2002 and a family member of situations (injury/decline/ the resident's doctor
Provide written records when a resident is transferred or discharged. 02/06/2001 01/06/2002 2 Few
Provide timely notification to the resident before transfer or discharge. 02/06/2001 01/06/2002 2 Few
Reasonably accommodate the needs and preferences of each resident. 02/06/2001 01/06/2002 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 MD Golden Living Center, Asheville
RN Staff Only1 N/A N/A 4 out of 5 stars
Total Number of Residents 86 105 247
Total, Licensed Nurse Staff Hours
per Resident per Day
16 hours 51 minutes 6 hours 54 minutes 2 hours 54 minutes
RN Hours
per Resident per Day
16 hours 3 minutes 6 hours 1 minute 1 hour 15 minutes
LPN/LVN Hours
per Resident per Day
16 hours 17 minutes 6 hours 7 minutes 1 hour 39 minutes
CNA Hours
per Resident per Day
17 hours 46 minutes 7 hours 35 minutes 2 hours 36 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: 04/09/2012

Automatic Sprinkler Systems in all required areas Yes
Date of last standard fire safety inspection: 04/09/2012
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 MD: 0
Average number of Fire Safety Deficiencies in US: 2
Range of Fire Safety Deficiencies in MD: 0 - 0

Inspection, 01/04/2009

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. 01/04/2009 00/01/2010 1 Many
Furnishings and Decorations Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Exits that are free from obstructions and can be used at all times. 01/04/2009 00/01/2010 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. 01/04/2009 00/01/2010 2 Few
Smoke Compartmentation and Control Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Walls that prevent smoke from passing through and would resist fire for at least one hour. 01/04/2009 00/01/2010 2 Few

Inspection, 00/09/2004

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. 00/09/2004 02/05/2004 1 Some
Properly working alarms on sprinkler valves. 00/09/2004 02/05/2004 2 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. 00/09/2004 02/05/2004 2 Few
Interior Finish Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Fire resistant room wall surfaces. 00/09/2004 02/05/2004 1 Some
Medical Gases and Anesthetizing Areas Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Proper medical gas storage and administration areas. 00/09/2004 02/05/2004 2 Few
Smoke Compartmentation and Control Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Walls that prevent smoke from passing through and would resist fire for at least one hour. 00/09/2004 02/05/2004 2 Few
 

4922 Lasalle Road
Hyattsville, MD 20782

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