Provider Name: WINDSOR QUAIL VALLEY POST-ACUTE HEALTHCARE
Address: 3640 HAMPTON DR, MISSOURI CITY, TX 77459
Phone: (281) 778-5144
County: Fort Bend (530)
Ownership Type: Non profit - Corporation
Certified Beds: 120
Average Residents Per Day: 95.2 ()
Provider Type: Medicare and Medicaid, Resides in Hospital: No
Legal Business Name: OAKBEND MEDICAL CENTER
First Approved Date: September 23, 2014
Affiliated Entity: REGENCY INTEGRATED HEALTH SERVICES (441)
Retirement Community: N, Special Focus Status:
Ownership Change in Last 12 Months: N
Resident Family Council: Resident
Sprinkler System Status: Yes
Overall Rating: 5 ()
Health Inspection Rating: 5 ()
QM Rating: 5 ()
Long Stay QM Rating: 5 ()
Short Stay QM Rating: 3 ()
Staffing Rating: 1 ()
Staffing Report Note:
PT Staffing Note:
Nurse Aide Staff Hours Per Day, per resident: 2.04071, LPN Staff Hours Per Day: 0.8354, RN Staff Hours Per Day: 0.3465, Licensed Staff Hours Per Day: 1.1819
Total Nurse Staff Hours Per Day, per resident: 3.22269
Weekend Nurse Staff Hours: 2.87758, Weekend RN Staff Hours: 0.2506
PT Staff Hours Per Day, per resident: 0.0801
Nurse Staff Turnover: 64.8, Nurse Turnover Note:
RN Turnover: 75.0, RN Turnover Note:
Admin Left Number: 0, Admin Turnover Note:
Case Mix Nurse Aide Hours Per Day, per resident: 2.1688, Case Mix LPN Hours Per Day: 0.8717, Case Mix RN Hours Per Day: 0.4800
Adjusted Nurse Aide Hours Per Day, per resident: 1.91690, Adjusted LPN Hours Per Day: 0.7072, Adjusted RN Hours Per Day: 0.2720
Total Adjusted Nurse Hours Per Day, per resident: 2.88529
Adjusted Weekend Nurse Hours Per Day, per resident: 2.57631
Health Survey Dates and Scores: Cycle 1: 2024-01-25 (Score: 0), Cycle 2: 2022-10-18 (Score: 28), Cycle 3: 2021-08-17 (Score: 36)
Total Weighted Health Score: 15.333
Reported Incidents: 1, Substantiated Complaints: 1
Infection Control Citations: 1
Fines and Penalties: Number of Fines: 4, Total Fines in Dollars: 17925.00, Payment Denials Number: 0, Total Penalties Number: 4
Location and GPS: 3640 HAMPTON DR,MISSOURI CITY,TX,77459 (29.5676, -95.562)
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 services provided by the nursing facility meet professional standards of quality.
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 2022-11-11
Type: Health, Deficiency: Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
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 2022-11-11
Type: Health, Deficiency: Ensure medication error rates are not 5 percent or greater.
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 2022-11-11
Type: Health, Deficiency: Provide and implement an infection prevention and control program.
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 2022-11-11
Type: Health, Deficiency: Honor the resident's right to receive visitors of his or her choosing, at the time of his or her choosing.
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 2022-03-21
Type: Health, Deficiency: Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
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 2021-12-03
Type: Health, Deficiency: Provide safe and appropriate respiratory care for a resident when needed.
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 2021-12-03
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 2021-11-25
Type: Health, Deficiency: Post nurse staffing information every day.
Severity: C - Level 1: No actual harm with potential for minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2021-09-08
Type: Health, Deficiency: Keep all essential equipment working safely.
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 2021-09-08
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: 0929, Version: New
Description: Ensure precautions for handling oxygen cylinders and equipment are correctly followed.
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 2024-02-20
Type: Fire Safety, Tag: 0324, Version: New
Description: Provide properly protected cooking facilities.
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 2022-11-11
Type: Fire Safety, Tag: 0345, Version: New
Description: Have approved installation, maintenance and testing program for fire alarm systems.
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 2021-09-08