Provider Name: BAYOU MANOR
Address: 4141 S BRAESWOOD BLVD, HOUSTON, TX 77025
Phone: (713) 666-2651
County: Harris (610)
Ownership Type: Non profit - Corporation
Certified Beds: 37
Average Residents Per Day: 32.7 ()
Provider Type: Medicare, Resides in Hospital: No
Legal Business Name: BRAZOS PRESBYTERIAN HOMES INC
First Approved Date: May 18, 2011
Affiliated Entity: ()
Retirement Community: Y, Special Focus Status:
Ownership Change in Last 12 Months: N
Resident Family Council: Both
Sprinkler System Status: Yes
Overall Rating: 3 ()
Health Inspection Rating: 4 ()
QM Rating: 2 ()
Long Stay QM Rating: 2 ()
Short Stay QM Rating: 2 ()
Staffing Rating: 1 (12)
Staffing Report Note:
PT Staffing Note:
Nurse Aide Staff Hours Per Day, per resident: 4.12497, LPN Staff Hours Per Day: 1.4649, RN Staff Hours Per Day: 0.3611, Licensed Staff Hours Per Day: 1.8260
Total Nurse Staff Hours Per Day, per resident: 5.95099
Weekend Nurse Staff Hours: 5.31208, Weekend RN Staff Hours: 0.1193
PT Staff Hours Per Day, per resident: 0.0649
Nurse Staff Turnover: 45.7, Nurse Turnover Note:
RN Turnover: 83.3, RN Turnover Note:
Admin Left Number: , Admin Turnover Note: 6
Case Mix Nurse Aide Hours Per Day, per resident: 2.1420, Case Mix LPN Hours Per Day: 0.7226, Case Mix RN Hours Per Day: 0.3257
Adjusted Nurse Aide Hours Per Day, per resident: 3.92324, Adjusted LPN Hours Per Day: 1.4959, Adjusted RN Hours Per Day: 0.4177
Total Adjusted Nurse Hours Per Day, per resident: 5.87938
Adjusted Weekend Nurse Hours Per Day, per resident: 5.24815
Health Survey Dates and Scores: Cycle 1: 2023-06-15 (Score: 24), Cycle 2: 2022-05-06 (Score: 0), Cycle 3: 2020-01-24 (Score: 36)
Total Weighted Health Score: 18.000
Reported Incidents: 0, Substantiated Complaints: 0
Infection Control Citations: 0
Fines and Penalties: Number of Fines: 14, Total Fines in Dollars: 58817.27, Payment Denials Number: 0, Total Penalties Number: 14
Location and GPS: 4141 S BRAESWOOD BLVD,HOUSTON,TX,77025 (29.6874, -95.445)
Process Date: 2024-03-01
Each record details specific health deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Health, Deficiency: Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has plan of correction on 2023-07-15
Type: Health, Deficiency: Ensure each resident’s drug regimen must be free from unnecessary drugs.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has plan of correction on 2023-07-15
Type: Health, Deficiency: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has plan of correction on 2023-07-15
Type: Health, Deficiency: Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-02-14
Type: Health, Deficiency: Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-02-14
Type: Health, Deficiency: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-01-31
Type: Health, Deficiency: Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-01-31
Type: Health, Deficiency: Provide and implement an infection prevention and control program.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-02-14
Each record details specific fire safety deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Fire Safety, Tag: 0223, Version: New
Description: Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-07-03
Type: Fire Safety, Tag: 0372, Version: New
Description: Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-06-10
Type: Fire Safety, Tag: 0345, Version: New
Description: Have approved installation, maintenance and testing program for fire alarm systems.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-02-14