General Information: SERENE MANOR MEDICAL CTR.
Nursing home name SERENE MANOR MEDICAL CTR.
Address970 WRAY ST
KNOXVILLE, TN 37917
Phone number (865) 523-9171
Located within a hospital No
Type of ownership Non profit - Other
Owner operates multiple homesNo
Accept Medicare or Medicaid Medicaid
Continue Care Retirement CommunityNo
Resident and family councils Both
Certified number of beds 79
Total number of residents 74
Perc of occupied beds 93
Sprinkler status Yes
Number of Facility Reported Incidents0
Number of Substantiated Complaints5
Number of Fines0
Total Amount of Fines$0
Total Number of Penalties0
Total Number of Penalties0
Ratings Summary: SERENE MANOR MEDICAL CTR.
Overall rating 4
4
Nursing Home Staffing 4
4
Registered Nurses only 4
4
Health Inspections 3
3
Quality Measures 4
4
Nursing Home Staffing Info: SERENE MANOR MEDICAL CTR.
National AverageTennessee AverageSERENE MANOR MEDICAL CTR.
Overall staff rating NA NA 4
4
Registered Nurses only rating NANA 4
4
Total Number of Residents NA NA 74
Total Number of Nurse Staff Hours per Resident per Day 4.11 hours 3.95 hours 3.34 hours
Total Number of Licensed Nurse Staff Hours per Resident per Day 1.64 hours 1.7 hours 1.35 hours
Registered Nurses Hours per Residents per Day 0.81 hours 0.67 hours 0.56 hours
Licensed Practical or Vacation Nurses Hours per Resident per Day 0.83 hours 1.03 hours 0.79 hours
Certified Nursing Assistants Hours per Residents per Day 2.47 hours 2.26 hours 1.99 hours
Physical Therapy Staffing Hours per Resident Per Day 0.1 hours 0.1 hours 0.02 hours
Health Survey: SERENE MANOR MEDICAL CTR.
Heath Survey Summary on 2013-03-27
Total Number of Health Deficiencies 8
Scope and Severity of most Severe Health Deficiency Pattern/Minimal harm or potential for actual harm
Heath Survey Summary on 2011-08-10
Total Number of Health Deficiencies 1
Scope and Severity of most Severe Health Deficiency Isolated/Minimal harm or potential for actual harm
Heath Survey Summary on 2011-02-02
Total Number of Health Deficiencies 5
Scope and Severity of most Severe Health Deficiency Isolated/Minimal harm or potential for actual harm
Health Survey Details: SERENE MANOR MEDICAL CTR.
Inspection Results: 03/27/2013
Corrected Deficiency Scope and Severity
04/15/2013 Conduct initial and periodic assessments of each resident's functional capacity. Isolated/Minimal harm or potential for actual harm
04/15/2013 Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Isolated/Minimal harm or potential for actual harm
04/15/2013 Assist those residents who need help with eating/drinking, grooming and personal and oral hygiene. Isolated/Minimal harm or potential for actual harm
04/15/2013 Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. Pattern/Minimal harm or potential for actual harm
04/15/2013 Post nurse staffing information/data on a daily basis. Widespread/Potential for minimal harm
04/15/2013 Dispose of garbage and refuse properly. Widespread/Potential for minimal harm
04/15/2013 Have a program that investigates, controls and keeps infection from spreading. Pattern/Minimal harm or potential for actual harm
04/15/2013 Keep accurate, complete and organized clinical records on each resident that meet professional standards. Isolated/Minimal harm or potential for actual harm
Inspection Results: 08/10/2011
Corrected Deficiency Scope and Severity
08/22/2011 Keep accurate, complete and organized clinical records on each resident that meet professional standards. Isolated/Minimal harm or potential for actual harm
Inspection Results: 02/02/2011
Corrected Deficiency Scope and Severity
02/18/2011 Allow residents the right to participate in the planning or revision of care and treatment. Isolated/Minimal harm or potential for actual harm
02/18/2011 Keep each resident free from physical restraints, unless needed for medical treatment. Isolated/Minimal harm or potential for actual harm
02/18/2011 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
02/18/2011 Post nurse staffing information/data on a daily basis. Widespread/Potential for minimal harm
02/18/2011 Give or get quality laboratory services/tests in a timely manner to meet the needs of residents. Isolated/Minimal harm or potential for actual harm

Fire Safety Survey: SERENE MANOR MEDICAL CTR.
Fire Safety Survey Summary on 2013-03-26
Total Number of Fire SafetyDeficiencies 3
Scope and Severity of most Severe Health Deficiency Isolated/Minimal harm or potential for actual harm
Fire Safety Survey Summary on 2011-08-09
Total Number of Fire SafetyDeficiencies 4
Scope and Severity of most Severe Health Deficiency Pattern/Minimal harm or potential for actual harm
Fire Safety Survey Summary on 2011-02-01
Total Number of Fire SafetyDeficiencies 4
Scope and Severity of most Severe Health Deficiency Pattern/Minimal harm or potential for actual harm
Fire Safety Survey: SERENE MANOR MEDICAL CTR.
Fire Safety Survey Results: 03/26/2013
Corrected Deficiency Severity
04/12/2013 Properly working alarms on sprinkler valves. Isolated/Minimal harm or potential for actual harm
05/11/2013 Automatic sprinkler systems that have been maintained in working order. Isolated/Minimal harm or potential for actual harm
05/11/2013 Restrictions on the use of highly flammable decorations. Isolated/Minimal harm or potential for actual harm
Fire Safety Survey Results: 08/09/2011
Corrected Deficiency Severity
08/22/2011 Record of quarterly fire drills for each shift under varying conditions. Pattern/Minimal harm or potential for actual harm
08/22/2011 Proper construction of ducts through walls designed to prevent smoke passage. Isolated/Minimal harm or potential for actual harm
08/22/2011 Emergency lighting that can last at least 1 1/2 hours. Isolated/Minimal harm or potential for actual harm
08/22/2011 Corridor and hallway doors that block smoke. Isolated/Minimal harm or potential for actual harm
Fire Safety Survey Results: 02/01/2011
Corrected Deficiency Severity
02/07/2011 Corridor and hallway doors that block smoke. Isolated/Minimal harm or potential for actual harm
03/07/2011 Proper stairway enclosures and vertical shafts. Isolated/Minimal harm or potential for actual harm
03/02/2011 Special areas constructed so that walls can resist fire for one hour or an approved fire extinguishing system. Isolated/Minimal harm or potential for actual harm
03/02/2011 Automatic sprinkler systems that have been maintained in working order. Pattern/Minimal harm or potential for actual harm

Resident Complaints: SERENE MANOR MEDICAL CTR.
Date Complaint Substantiated: 12/12/2012
CorrectedCategoryDeficiencySeverity
12/15/2012Develop 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
Date Complaint Substantiated: 07/05/2012
CorrectedCategoryDeficiencySeverity
07/30/2012Keep residents' personal and medical records private and confidential. D
Date Complaint Substantiated: 01/05/2012
CorrectedCategoryDeficiencySeverity
02/19/2012Keep residents' personal and medical records private and confidential. E
01/20/20121) 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
01/20/2012Maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards. D

Quality Measures: SERENE MANOR MEDICAL CTR.
Quality Measures National Average Tennessee Average SERENE MANOR MEDICAL CTR.
Overall quality rating NA NA 4
4
Long-Stay Residents
Percent of Long Stay Residents Whose Need for Help with ADLs has Increased 15.4% 15.5% 3.1%
Percent of Long Stay Residents Who Self Report Moderate to Severe Pain 8.3% 6.9% 44.9%
Percent of High Risk Long Stay Residents With Pressure Ulcers 6.1% 5.2% 3.6%
Percent of Long Stay Residents Who Lose Too Much Weight 7.2% 8.2% 1.8%
Percent of Low Risk Long Stay Residents Who Lose Control of Their Bowel or Bladder 43.9% 45.6% 12.7%
Percent of Long Stay Residents with a Catheter Inserted and Left in Their Bladder 3.2% 3.3% 0.0%
Percent of Long Stay Residents With a Urinary Tract Infection 6.2% 7.8% 9.1%
Percent of Long Stay Residents Who Have Depressive Symptoms 6.3% 3.4% 0.5%
Percent of Long Stay Residents Who Were Physically Restrained 1.4% 2.7% 4.5%
Percent of Long Stay Residents Experiencing One or More Falls with Major Injury 3.2% 3.5% 2.7%
Percent of Long Stay Residents Assessed and Appropriately Given the Seasonal Influenza Vaccine 92.7% 93.4% 90.8%
Percent of Long Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine 94.3% 93.5% 100.0%
Percent of Long Stay Residents Who Received an Antipsychotic Medication 20.7% 24.3% 33.7%
Short-Stay Residents
Percent of Short Stay Residents Who Self Report Moderate to Severe Pain 19.2% 17.8% %
Percent of Short Stay Residents With Pressure Ulcers That Are New or Worsened 1.2% 0.8% 0.0%
Percent of Short Stay Residents Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine 83.4% 85.4% 93.7%
Percent of Short Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine 82.4% 82.6% 97.0%
Percent of Short Stay Residents Who Newly Received an Antipsychotic Medication 2.6% 3.1% %

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