Canterbury Woods

Canterbury Woods

725 Renaissance Drive

Williamsville, NY 14221

7169295800

http:canterburywoods.org/

Services: Baseline Services, Outpatient/Occupational Therapy, Outpatient/Physical Therapy, Outpatient/Speech Language Pathology Therapy

Beds

Behavioral Intervention:
Pediatric:
Pediatric Ventilator Dependent:
Residential Health Care:48
Transitional Care Unit:
Ventilator Dependent:
Total Number of Beds:48

Administrative

Ownership: Voluntary--Not for Profit Corporation

Operated by: Episcopal Church Home & Affiliates Life Care Community Inc
725 Renaissance Drive
Williamsville, NY 14221

Permanent Facility Identifier: 7789

Operating Certificate: 1421305N

Medicaid Certified

Medicare Certified

Medicare Number: 335816

Statistics

Employee Flu Vaccination Rate: 78%

Occupancy Rate: 98%

Nursing Home CMS Quality (Short Stay)

Measure CodeMeasure DescriptionAverage ScoreFootnoteProcessing Date
430Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine88.57109/1/2020
434Percentage of short-stay residents who newly received an antipsychotic medication1.06409/1/2020
471Percentage of short-stay residents who made improvements in function89.27009/1/2020

Nursing Home CMS Quality (Long Stay)

Measure CodeMeasure DescriptionAverage ScoreFootnoteProcessing Date
401Percentage of long-stay residents whose need for help with daily activities has increased11.429011/1/2019
404Percentage of long-stay residents who lose too much weight2.878011/1/2019
405Percentage of low risk long-stay residents who lose control of their bowels or bladder76.190011/1/2019
406Percentage of long-stay residents with a catheter inserted and left in their bladder4.367011/1/2019
407Percentage of long-stay residents with a urinary tract infection5.960011/1/2019
408Percentage of long-stay residents who have depressive symptoms0.000011/1/2019
409Percentage of long-stay residents who were physically restrained0.000011/1/2019
410Percentage of long-stay residents experiencing one or more falls with major injury2.614011/1/2019
415Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine94.118011/1/2019
419Percentage of long-stay residents who received an antipsychotic medication20.261011/1/2019
451Percentage of long-stay residents whose ability to move independently worsened15.356011/1/2019
452Percentage of long-stay residents who received an antianxiety or hypnotic medication11.348011/1/2019

Complaints

Number of Standard Health Deficiencies:13
Number of Live Safety Code Deficiencies:8
Number of Total Deficiencies:21
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):34
Intakes received per 100 occupied beds (last three years):75.0
Percent of total intakes received that were facility self reported incidents (last three years):74
On-site complaint investigations (last three years):7
Complaint investigations resulting in citations (last three years):2
Complaint investigations resulting in citations per 100 occupied beds (last three years):4.4
Complaint Citations in deficiency category: Administration:0
Complaint Citations in deficiency category: Quality of Care:0
Complaint Citations in deficiency category: Resident Rights:1
Complaint Citations in deficiency category: Dietary Services:0
Complaint Citations in deficiency category: Physical Environment:0
Complaint Citations in deficiency category: Other Services:1
Complaint Citations across all deficiency categories (last three years):4

Enforcements

Survey DateDeficiency CategoryStipulation DateFine Assessed

Surveys

Initial Survey DateSurvey TypeTotal Visits Required
42986CERTIFICATION/COMPLAINT2
43136COMPLAINT2
43410CERTIFICATION/COMPLAINT2
43769CERTIFICATION2
43984COMPLAINT1
44022COMPLAINT1

Citations

Inspection TypeDeficiencySeverityResidents AffectedDate of Initial SurveyDate Citation Corrected
HealthDEVELOP/IMPLEMENT ABUSE/NEGLECT POLICIES2111/6/20181/4/2019
HealthDRUG REGIMEN REVIEW, REPORT IRREGULAR, ACT ON2211/6/20181/4/2019
HealthESSENTIAL EQUIPMENT, SAFE OPERATING CONDITION2211/6/20181/4/2019
HealthFREE FROM UNNEC PSYCHOTROPIC MEDS/PRN USE2211/6/20181/4/2019
HealthINFECTION CONTROL2311/6/20181/4/2019
HealthINFECTION PREVENTION & CONTROL2311/6/20181/4/2019
LSCELECTRICAL SYSTEMS - ESSENTIAL ELECTRIC SYSTE2111/6/20181/4/2019
LSCELECTRICAL SYSTEMS - ESSENTIAL ELECTRIC SYSTE2111/6/20181/4/2019
LSCFUNDAMENTALS - BUILDING SYSTEM CATEGORIES2211/6/20181/4/2019
LSCSPRINKLER SYSTEM - MAINTENANCE AND TESTING2211/6/20181/4/2019
LSCSUBDIVISION OF BUILDING SPACES - SMOKE BARRIE2211/6/20181/4/2019
HealthDEPARTMENT CRIMINAL HISTORY REVIEW2211/6/201810/24/2017
HealthFOOD PROCURE, STORE/PREPARE/SERVE - SANITARY2211/6/201810/24/2017
HealthFREE OF ACCIDENT HAZARDS/SUPERVISION/DEVICES2211/6/201810/24/2017
HealthMAINTAINS EFFECTIVE PEST CONTROL PROGRAM2111/6/201810/24/2017
HealthNOTIFY OF CHANGES (INJURY/DECLINE/ROOM, ETC)2111/6/201810/24/2017
LSCELECTRICAL SYSTEMS - ESSENTIAL ELECTRIC SYSTE2211/6/201810/24/2017
LSCSPRINKLER SYSTEM - INSTALLATION2211/6/201810/24/2017
HealthFREE FROM UNNEC PSYCHOTROPIC MEDS/PRN USE2111/6/201812/20/2019
LSCSOILED LINEN AND TRASH CONTAINERS2211/6/201812/20/2019
HealthFREE FROM ABUSE AND NEGLECT2111/6/20183/27/2018