Mercy Hospital Skilled Nursing Facility

Mercy Hospital Skilled Nursing Facility

55 Melroy Avenue

Lackawanna, NY 14218

7168282300

www.chsbuffalo.org/Facilities/NursingHomes/MercySNF

Services: Baseline Services, Clinical Laboratory Service, Radiology - Diagnostic

Beds

Behavioral Intervention:
Pediatric:
Pediatric Ventilator Dependent:
Residential Health Care:84
Transitional Care Unit:
Ventilator Dependent:
Total Number of Beds:84

Administrative

Ownership: Voluntary--Not for Profit Corporation

Operated by: Mercy Hospital of Buffalo Inc
565 Abbott Road
Buffalo, NY 14220

Permanent Facility Identifier: 214

Operating Certificate: 1401008N

Medicaid Certified

Medicare Certified

Medicare Number: 335308

Statistics

Employee Flu Vaccination Rate: 76%

Occupancy Rate: 100%

Nursing Home CMS Quality (Short Stay)

Measure CodeMeasure DescriptionAverage ScoreFootnoteProcessing Date
424Percentage of short-stay residents who self-report moderate to severe pain0.00005/1/2019
430Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine71.74005/1/2019
434Percentage of short-stay residents who newly received an antipsychotic medication0.000095/1/2019
471Percentage of short-stay residents who made improvements in function0.000095/1/2019

Nursing Home CMS Quality (Long Stay)

Measure CodeMeasure DescriptionAverage ScoreFootnoteProcessing Date
401Percentage of long-stay residents whose need for help with daily activities has increased9.90005/1/2019
402Percentage of long-stay residents who self-report moderate to severe pain5.63005/1/2019
404Percentage of long-stay residents who lose too much weight4.78005/1/2019
405Percentage of low risk long-stay residents who lose control of their bowels or bladder81.13005/1/2019
406Percentage of long-stay residents with a catheter inserted and left in their bladder0.29005/1/2019
407Percentage of long-stay residents with a urinary tract infection1.86005/1/2019
408Percentage of long-stay residents who have depressive symptoms0.97005/1/2019
409Percentage of long-stay residents who were physically restrained0.00005/1/2019
410Percentage of long-stay residents experiencing one or more falls with major injury4.97005/1/2019
415Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine98.14005/1/2019
419Percentage of long-stay residents who received an antipsychotic medication12.15005/1/2019
451Percentage of long-stay residents whose ability to move independently worsened18.21005/1/2019
452Percentage of long-stay residents who received an antianxiety or hypnotic medication22.47005/1/2019

Complaints

Number of Standard Health Deficiencies:9
Number of Live Safety Code Deficiencies:9
Number of Total Deficiencies:18
Number of Deficiencies related to Actual Harm or Immediate Jeopardy:0
Percent of Total Deficiencies related to Actual Harm or Immediate Jeopardy :0
Total intakes received (last three years):7
Intakes received per 100 occupied beds (last three years):8.3
Percent of total intakes received that were facility self reported incidents (last three years):86
On-site complaint investigations (last three years):4
Complaint investigations resulting in citations (last three years):1
Complaint investigations resulting in citations per 100 occupied beds (last three years):1.2
Complaint Citations in deficiency category: Administration:0
Complaint Citations in deficiency category: Quality of Care:1
Complaint Citations in deficiency category: Resident Rights:0
Complaint Citations in deficiency category: Dietary Services:0
Complaint Citations in deficiency category: Physical Environment:0
Complaint Citations in deficiency category: Other Services:0
Complaint Citations across all deficiency categories (last three years):1

Enforcements

Survey DateDeficiency CategoryStipulation DateFine Assessed

Surveys

Initial Survey DateSurvey TypeTotal Visits Required
12/21/2018CERTIFICATION2
12/5/2017CERTIFICATION2
8/6/2015CERTIFICATION2
9/12/2016CERTIFICATION/COMPLAINT2

Citations

Inspection TypeDeficiencySeverityResidents AffectedDate of Initial SurveyDate Citation Corrected
LSCLIFE SAFETY CODE STANDARD219/12/201610/14/2016
LSCLIFE SAFETY CODE STANDARD229/12/201610/14/2016
LSCLIFE SAFETY CODE STANDARD229/12/201610/14/2016
LSCLIFE SAFETY CODE STANDARD229/12/201610/14/2016
LSCLIFE SAFETY CODE STANDARD229/12/201610/14/2016
HealthDEVELOP COMPREHENSIVE CARE PLANS219/12/201610/28/2016
HealthRES RECORDS-COMPLETE/ACCURATE/ACCESSIBLE219/12/201610/28/2016
HealthTREATMENT/CARE FOR SPECIAL NEEDS219/12/201610/28/2016
HealthREQUIREMENTS BEFORE SUBMITTING A REQUEST FOR219/12/201610/7/2016
LSCELECTRICAL EQUIPMENT - POWER CORDS AND EXTENS2212/5/201712/18/2017
LSCSPRINKLER SYSTEM - MAINTENANCE AND TESTING2312/5/201712/18/2017
LSCELECTRICAL SYSTEMS - OTHER2212/5/201712/29/2017
HealthFREE FROM UNNEC PSYCHOTROPIC MEDS/PRN USE2112/21/20182/15/2019
LSCELECTRICAL SYSTEMS - ESSENTIAL ELECTRIC SYSTE2212/21/20182/15/2019
HealthFREE OF ACCIDENT HAZARDS/SUPERVISION/DEVICES218/6/20159/25/2015
HealthINVESTIGATE/REPORT ALLEGATIONS/INDIVIDUALS218/6/20159/25/2015
HealthPROVIDE CARE/SERVICES FOR HIGHEST WELL BEING218/6/20159/25/2015
HealthRES RECORDS-COMPLETE/ACCURATE/ACCESSIBLE128/6/20159/25/2015