Maple Leaf Health Care

2640 DAVIE AVENUE

Statesville, NC 28625

(704) 871-0705

General

Ratings

Deficiencies

Resident Stats

Staff Stats

Certified Beds:	94
Number of Residents:	86
Percent of Occupied Beds:	91%
Sprinkler Status:	Fully Sprinklered
Program Participation:	Medicare and Medicaid
Type of Ownership:	For profit - Limited liability company
Located Within a Hospital?	No
Multi Nursing Home Ownership?	Yes
Resident and Family Councils?	Resident
Continuing Care Retirement Community?	No
Quality Indicator Survey?	Yes
Special Focus Facility?	No

Date	Type	Category	Deficiency	Scope	Level of Harm	Date of Correction
20071107	Health	Resident Rights Deficiencies	Tell each resident who can get Medicaid benefits about 1) which items and services Medicaid covers and which the resident must pay for; or 2) how to apply for Medicaid, along with the names and addresses of State groups that can help.	Pattern	Potential for minimal harm	20071205
20071107	Health	Resident Rights Deficiencies	Provide care in a way that keeps or builds each resident's dignity and self respect.	Isolated	Minimal harm or potential for actual harm	20071205

	Value	Notes
Percent of long-stay residents given influenza vaccination during the flu season:	95
Percent of long-stay residents who were assessed and given pneumococcal vaccination:	99
Percent of long-stay residents whose need for help with daily activities has increased:	9
Percent of long-stay residents who have moderate to severe pain:	0
Percent of high-risk long-stay residents who have pressure sores:	5
Percent of low-risk long-stay residents who have pressure sores:	3
Percent of long-stay residents who were physically restrained:	1
Percent of long-stay residents who are more depressed or anxious:	12
Percent of low-risk long-stay residents who lose control of their bowels or bladder:	66
Percent of long-stay residents who have/had a catheter inserted and left in their bladder:	1
Percent of long-stay residents who spend most of their time in bed or in a chair:	6
Percent of long-stay residents whose ability to move about in and around their room got worse:	12
Percent of long-stay residents who had a urinary tract infection:	4
Percent of long-stay residents who lose too much weight:	7
Percent of short-stay residents given influenza vaccination during the flu season:	89
Percent of short-stay residents who were assessed and given pneumococcal vaccination:	92
Percent of short-stay residents who have delirium:	0
Percent of short-stay residents who had moderate to severe pain:	6
Percent of short-stay residents who have pressure sores:	8

# of Residents:	86
# RN Hours per Resident:	0.46
# LPN Hours per Resident:	0.81
# CNA Hours per Resident:	2.1
Total Staff Hours per Resident:	1.27

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