General Information: CALVERT CITY CONVALESCENT CENTER
Nursing home name CALVERT CITY CONVALESCENT CENTER
Address1201 FIFTH AVE
CALVERT CITY, KY 42029
Phone number (270) 395-4124
Located within a hospital No
Type of ownership Non profit - Corporation
Owner operates multiple homesNo
Accept Medicare or Medicaid Medicare and Medicaid
Continue Care Retirement CommunityNo
Resident and family councils Resident
Certified number of beds 95
Total number of residents 85
Perc of occupied beds 89
Sprinkler status Yes
Number of Facility Reported Incidents0
Number of Substantiated Complaints2
Number of Fines1
Total Amount of Fines$10238
Total Number of Penalties0
Total Number of Penalties1
Ratings Summary: CALVERT CITY CONVALESCENT CENTER
Overall rating 4
4
Nursing Home Staffing 4
4
Registered Nurses only 4
4
Health Inspections 3
3
Quality Measures 2
2
Nursing Home Staffing Info: CALVERT CITY CONVALESCENT CENTER
National AverageKentucky AverageCALVERT CITY CONVALESCENT CENTER
Overall staff rating NA NA 4
4
Registered Nurses only rating NANA 4
4
Total Number of Residents NA NA 85
Total Number of Nurse Staff Hours per Resident per Day 4.11 hours 4.38 hours 4.27 hours
Total Number of Licensed Nurse Staff Hours per Resident per Day 1.64 hours 1.85 hours 1.56 hours
Registered Nurses Hours per Residents per Day 0.81 hours 0.89 hours 0.74 hours
Licensed Practical or Vacation Nurses Hours per Resident per Day 0.83 hours 0.96 hours 0.82 hours
Certified Nursing Assistants Hours per Residents per Day 2.47 hours 2.53 hours 2.71 hours
Physical Therapy Staffing Hours per Resident Per Day 0.1 hours 0.09 hours 0.07 hours
Health Survey: CALVERT CITY CONVALESCENT CENTER
Heath Survey Summary on 2014-01-22
Total Number of Health Deficiencies 4
Scope and Severity of most Severe Health Deficiency Pattern/Minimal harm or potential for actual harm
Heath Survey Summary on 2013-03-22
Total Number of Health Deficiencies 4
Scope and Severity of most Severe Health Deficiency Isolated/Actual harm
Heath Survey Summary on 2012-05-11
Total Number of Health Deficiencies 6
Scope and Severity of most Severe Health Deficiency Isolated/Actual harm
Health Survey Details: CALVERT CITY CONVALESCENT CENTER
Inspection Results: 01/22/2014
Corrected Deficiency Scope and Severity
02/22/2014 Provide housekeeping and maintenance services. Isolated/Minimal harm or potential for actual harm
02/22/2014 Develop policies and procedures for influenza and pneumococcal immunizations. Isolated/Minimal harm or potential for actual harm
02/22/2014 Provide routine and emergency drugs through a licensed pharmacist and only under the general supervision of a licensed nurse. Pattern/Minimal harm or potential for actual harm
02/22/2014 Have a program that investigates, controls and keeps infection from spreading. Pattern/Minimal harm or potential for actual harm
Inspection Results: 03/22/2013
Corrected Deficiency Scope and Severity
04/26/2013 Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. Isolated/Actual harm
04/26/2013 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. Isolated/Minimal harm or potential for actual harm
04/26/2013 Provide care for residents in a way that maintains or improves their dignity and respect in full recognition of their individuality. Isolated/Minimal harm or potential for actual harm
04/26/2013 Provide care by qualified persons according to each resident's written plan of care. Isolated/Actual harm
Inspection Results: 05/11/2012
Corrected Deficiency Scope and Severity
06/18/2012 Allow residents the right to participate in the planning or revision of care and treatment. Isolated/Minimal harm or potential for actual harm
06/18/2012 Ensure services provided by the nursing facility meet professional standards of quality. Isolated/Minimal harm or potential for actual harm
06/18/2012 Provide care by qualified persons according to each resident's written plan of care. Isolated/Minimal harm or potential for actual harm
06/18/2012 Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. Isolated/Minimal harm or potential for actual harm
06/18/2012 Give each resident enough fluids to keep them healthy and prevent dehydration. Isolated/Actual harm
06/18/2012 Keep accurate, complete and organized clinical records on each resident that meet professional standards. Pattern/Minimal harm or potential for actual harm

Fire Safety Survey: CALVERT CITY CONVALESCENT CENTER
Fire Safety Survey Summary on 2014-01-22
Total Number of Fire SafetyDeficiencies 0
Scope and Severity of most Severe Health Deficiency
Fire Safety Survey Summary on 2013-03-20
Total Number of Fire SafetyDeficiencies 3
Scope and Severity of most Severe Health Deficiency Widespread /Minimal harm or potential for actual harm
Fire Safety Survey Summary on 2012-05-08
Total Number of Fire SafetyDeficiencies 15
Scope and Severity of most Severe Health Deficiency Widespread /Minimal harm or potential for actual harm
Fire Safety Survey: CALVERT CITY CONVALESCENT CENTER
Fire Safety Survey Results: 03/20/2013
Corrected Deficiency Severity
03/27/2013 Properly maintained smoke detectors. Isolated/Minimal harm or potential for actual harm
04/22/2013 An approved automatic sprinkler system connected to the fire alarm system. Widespread /Minimal harm or potential for actual harm
04/20/2013 Proper medical gas storage and administration areas. Isolated/Minimal harm or potential for actual harm
Fire Safety Survey Results: 05/08/2012
Corrected Deficiency Severity
05/31/2012 Record of quarterly fire drills for each shift under varying conditions. Widespread /Minimal harm or potential for actual harm
06/15/2012 Restrictions on the use of highly flammable decorations. Widespread /Minimal harm or potential for actual harm
06/18/2012 Exits that are free from obstructions and can be used at all times. Isolated/Minimal harm or potential for actual harm
05/31/2012 Automatic sprinkler systems that have been maintained in working order. Widespread /Minimal harm or potential for actual harm
05/29/2012 An approved automatic sprinkler system connected to the fire alarm system. Isolated/Minimal harm or potential for actual harm
06/30/2012 Restrictions on the use of flammable curtains. Isolated/Minimal harm or potential for actual harm
06/18/2012 Proper backup exit lighting. Widespread /Minimal harm or potential for actual harm
05/21/2012 Exits that are accessible at all times. Widespread /Minimal harm or potential for actual harm
06/18/2012 Special areas constructed so that walls can resist fire for one hour or an approved fire extinguishing system. Pattern/Minimal harm or potential for actual harm
05/11/2012 Smoke barrier doors that can resist smoke for at least 20 minutes. Pattern/Minimal harm or potential for actual harm
05/29/2012 Walls that prevent smoke from passing through and would resist fire for at least one hour. Widespread /Minimal harm or potential for actual harm
06/18/2012 Corridor and hallway doors that block smoke. Pattern/Minimal harm or potential for actual harm
05/15/2012 Other fire safety features required by fire safety codes. Isolated/Minimal harm or potential for actual harm
06/18/2012 No-smoking signs where oxygen is used. Pattern/Minimal harm or potential for actual harm
06/18/2012 Properly installed electrical wiring and equipment. Widespread /Minimal harm or potential for actual harm

Resident Complaints: CALVERT CITY CONVALESCENT CENTER
Date Complaint Substantiated: 01/15/2013
CorrectedCategoryDeficiencySeverity
01/31/20131) 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. D
Date Complaint Substantiated: 07/11/2011
CorrectedCategoryDeficiencySeverity
07/28/2011Develop and implement policies for 1) screening and training employees; and the 2) prevention, identification, investigation, and reporting of any abuse, neglect, mistreatment and misappropriation of property. D

Quality Measures: CALVERT CITY CONVALESCENT CENTER
Quality Measures National Average Kentucky Average CALVERT CITY CONVALESCENT CENTER
Overall quality rating NA NA 2
2
Long-Stay Residents
Percent of Long Stay Residents Whose Need for Help with ADLs has Increased 15.4% 17.0% 13.0%
Percent of Long Stay Residents Who Self Report Moderate to Severe Pain 8.3% 9.6% 21.5%
Percent of High Risk Long Stay Residents With Pressure Ulcers 6.1% 6.6% 4.7%
Percent of Long Stay Residents Who Lose Too Much Weight 7.2% 8.2% 14.2%
Percent of Low Risk Long Stay Residents Who Lose Control of Their Bowel or Bladder 43.9% 45.7% 73.4%
Percent of Long Stay Residents with a Catheter Inserted and Left in Their Bladder 3.2% 4.1% 3.7%
Percent of Long Stay Residents With a Urinary Tract Infection 6.2% 7.5% 4.6%
Percent of Long Stay Residents Who Have Depressive Symptoms 6.3% 4.6% 3.5%
Percent of Long Stay Residents Who Were Physically Restrained 1.4% 2.7% 6.6%
Percent of Long Stay Residents Experiencing One or More Falls with Major Injury 3.2% 4.0% 5.7%
Percent of Long Stay Residents Assessed and Appropriately Given the Seasonal Influenza Vaccine 92.7% 94.7% 97.5%
Percent of Long Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine 94.3% 97.1% 98.4%
Percent of Long Stay Residents Who Received an Antipsychotic Medication 20.7% 22.2% 23.2%
Short-Stay Residents
Percent of Short Stay Residents Who Self Report Moderate to Severe Pain 19.2% 21.9% 25.0%
Percent of Short Stay Residents With Pressure Ulcers That Are New or Worsened 1.2% 1.4% 2.8%
Percent of Short Stay Residents Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine 83.4% 88.5% 93.1%
Percent of Short Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine 82.4% 87.8% 92.2%
Percent of Short Stay Residents Who Newly Received an Antipsychotic Medication 2.6% 3.1% 1.3%

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