GRAHAM OAKS CARE CENTER

The information listed below provides an in-depth look into the type and quality of care offered at Graham Oaks Care Center. It is important to note that when evaluating if a nursing home is right for you or a loved one, ratings should not be taken as the sole deciding factor, but as one of many aspects to be considered.

Address

GRAHAM OAKS CARE CENTER
1325 FIRST ST
GRAHAM, TX 76450
(940) 549-8787

Nursing Home Ratings

Health Inspections
Quality Measures
Nursing Staff
R.N. Staff Only

Overall Rating

Percent of Beds Occupied

73%

Number of Residents and Certified Beds

Residents: 87
Certified Beds: 120

This Facility Accepts

Medicare
Medicaid

Operational Details

Operated By For Profit - Corporation
Offers Both Resident and Family Counseling Services
This Facility is Not Part of a Chain or Franchise

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Nearby Cities:

Olney | Jacksboro | Breckenridge

Resident Services

The information below lists services this facility has provided for residents from October through December 2010. During this period, the most common type of service provided was "Ultra-High Rehabilitation". To get a better idea of the types of services that are commonly performed, compare the "Percent of Service Days" column below. These services are based on submitted claims to Medicare and do not provide a complete overview of all the services provided by Graham Oaks Care Center. For more information read our guide on how nursing facilities are reimbursed, types of services, and ADL index scores.

Resident Services

Resident Conditions

Percent of Service Days

Very High Rehabilitation Plus Extensive Services

Rehabilitation 500 Minutes Per Week Minimum

At least one rehabilitation discipline five days/week
Tracheostomy care
Ventilator or respirator
Isolation for active infectious disease while a resident
Activities of Daily Living (ADL) score of 2 or more

ADL Index Range: 11-16	3.5%
Total Percent:	3.5%

Medium Rehabilitation Plus Extensive Services

Rehabilitation 150 Minutes Per Week Minimum

Five days any combination of three rehabilitation disciplines
Tracheostomy care
Ventilator or respirator
Isolation for active infectious disease while a resident
Activities of Daily Living (ADL) score of 2 or more

ADL Index Range: 11-16	4.0%
Total Percent:	4.0%

Ultra-High Rehabilitation

Rehabilitation 720 Minutes Per Week Minimum

At least one rehabilitation discipline five days/week
A second rehabilitation discipline three days/week

ADL Index Range: 11-16	27.6%
ADL Index Range: 6-10	3.5%
ADL Index Range: 0-5	24.9%
Total Percent:	56.0%

Very High Rehabilitation

Rehabilitation 500 Minutes Per Week Minimum

At least one rehabilitation discipline five days/week

ADL Index Range: 11-16	14.9%
ADL Index Range: 6-10	4.9%
Total Percent:	19.8%

High Rehabilitation

Rehabilitation 325 Minutes Per Week Minimum

At least one rehabilitation discipline five days/week

ADL Index Range: 11-16	1.6%
Total Percent:	1.6%

Medium Rehabilitation

Rehabilitation 150 Minutes Per Week Minimum

Five days any combination of three rehabilitation disciplines

ADL Index Range: 11-16	4.3%
Total Percent:	4.3%

Extensive Services

Tracheostomy care
Ventilator or respirator
Isolation for active infectious disease while a resident
Activities of Daily Living (ADL) score of 2 or more

ADL Index Range: 2-16 - Tracheostomy care and ventilator/respirator	1.3%
Total Percent:	1.3%

Special Care High

Comatose
Septicemia
Diabetes with daily injections and a change of order two or more days
Quadriplegia with ADL score greater or equal to 5
Chronic Obstructive Pulmonary Disease (COPD) and shortness of breath when lying flat
Fever with pneumonia, or vomiting, or weight loss, or feeding tube
Parenteral/IV feedings
Respiratory therapy for 7 days
Activities of Daily Living (ADL) score of 2 or more

ADL Index Range: 11-14 - No Signs of depression	0.3%
Total Percent:	0.3%

Special Care Low

Cerebral palsy, multiple sclerosis, or Parkinson's disease with ADL score greater or equal to 5
Respiratory failure and oxygen therapy while a resident
Feeding tube where calories >= 51% or calories are in the range of 26-50% and fluid >= 501 mL)
Ulcers: 2 or more stage II or 1 or more stage III or IV pressure ulcers
Ulcers: 2 or more venous or arterial ulcers
Ulcers: 1 stage II pressure ulcer and 1 venous or arterial ulcer with 2 or more skin care treatments
Foot infection/diabetic foot ulcer/open lesions of foot with treatment
Radiation therapy while a resident
Dialysis while a resident
Activities of Daily Living (ADL) score of 2 or more

ADL Index Range: 15-16 - Signs of depression	2.1%
ADL Index Range: 11-14 - No Signs of depression	2.1%
ADL Index Range: 2-5 - No Signs of depression	0.3%
Total Percent:	4.4%

Clinically Complex

Pneumonia, hemiplegia with ADL score >=5
Surgical wounds or open lesions with treatment
Burns
Chemotherapy while a resident
Oxygen therapy while a resident
IV medications or transfusions while a resident
Extensive Services, Special Care High or Special Care Low qualifier and ADL score of 0 or 1

ADL Index Range: 15-16 - Signs of depression	2.1%
ADL Index Range: 2-5 - No Signs of depression	0.1%
Total Percent:	2.2%

Behavioral Symptoms and Cognitive Performance

Cognitive impairment BIMS score less than or equal to 9
CPS great than or equal to 3
Hallucinations or delusions
Physical or verbal behavioral symptoms toward others
Other behavioral symptoms
Rejection of care or wandering
Activities of Daily Living (ADL) score of 5 or less

ADL Index Range: 0-1 - Less restorative nursing	1.0%
Total Percent:	1.0%

Reduced Physical Function

Urinary and/or bowel training program
Passive and/or active range of motion (ROM)
Amputation/prosthesis training
Dressing or grooming training
Eating or swallowing training
Transfer training
Splint or brace assistance
Bed mobility and/or walking training
Communication training

ADL Index Range: 11-14 - Less restorative nursing	1.5%
Total Percent:	1.5%

Rating Details For Graham Oaks Care Center

Nursing Staff -

The nursing staff is the most important part of what determines the quality of care and comfort of a resident in a nursing home. Government regulations set expectations on time spent with each resident based on the services being provided. The breakdown below lists the nursing types (RN, LPN, LVN, CNA) and a comparison of the reported and expected hours per resident per day.

Nursing Hours Per Resident Per Day	Reported	Expected
Registered Nurse (RN) Hours	26 Minutes	1 Hour and 13 Minutes
Licensed Practical/Vocational Nurse (LPN/LVN) Hours	1 Hour and 6 Minutes	47 Minutes
Certified Nursing Assistant (CNA) Hours	2 Hours	2 Hours and 27 Minutes
Total Licensed Nurse Hours	1 Hour and 31 Minutes	2 Hours
Total Nurse Hours	3 Hours and 32 Minutes	4 Hours and 27 Minutes

Quality of Care -

Medicare determines quality of care ratings for nursing facilities by surveying several "quality measures", which are broken down into long-term and short-term stay residents, as well as if the action is preventive or if there is a deficiency in the quality of care. State averages for Texas are also provided for comparison purposes. Note: Figures below are averaged over the past nine months.

This Facility

Texas Average

Long-Term Stay Preventive Actions

Percent of Long-Stay Residents Given Influenza Vaccination During the Flu Season	90-100%	91%
Percent of Long-Stay Residents Who Were Assessed and Given Pneumococcal Vaccination	90-100%	88%

Long-Term Stay Deficiencies

Percent of Long-Stay Residents Who Have/Had a Catheter Inserted and Left in Their Bladder	18%	5%
Percent of Long-Stay Residents Whose Need for Help with Daily Activities Has Increased	19%	18%
Percent of Long-Stay Residents Who Had a Urinary Tract Infection	12%	9%
Percent of Low-Risk Long-Stay Residents Who Have Pressure Sores	2%	3%
Percent of High-Risk Long-Stay Residents Who Have Pressure Sores	17%	12%
Percent of Long-Stay Residents Whose Ability to Move About in and Around Their Room Got Worse	18%	12%
Percent of Long-Stay Residents Who Have Moderate to Severe Pain	2%	4%
Percent of Long-Stay Residents Who Were Physically Restrained	3%	4%
Percent of Low-Risk Long-Stay Residents Who Lose Control of Their Bowels or Bladder	36%	46%
Percent of Long-Stay Residents Who Are More Depressed or Anxious	8%	13%
Percent of Long-Stay Residents Who Lose Too Much Weight	4%	6%
Percent of Long-Stay Residents Who Spend Most of Their Time in Bed or in a Chair	8%	6%

Short-Term Stay Preventive Actions

Percent of Short-Stay Residents Given Influenza Vaccination During the Flu Season	90-100%	84%
Percent of Short-Stay Residents Who Were Assessed and Given Pneumococcal Vaccination	90-100%	79%

Short-Term Stay Deficiencies

Percent of Short-Stay Residents Who Have Pressure Sores	9%	11%
Percent of Short-Stay Residents Who Have Delirium	4%	3%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain	8%	16%

Health Inspection Details -

All Medicare and/or Medicaid certified nursing home must undergo health inspections on average once a year, but may be more frequent if the facility is peforming poorly. These inspections cover most aspects of life in a nursing home, and are broken down into deficiencies types, which including: Pharmacy Service, Administration, Resident Rights, Nutrition and Dietary, Resident Assessment, Environmental, and Mistreatment. Below are the list of deficiencies found by inspectors in the past few years along with the degree of harm and how many residents may have been affected. Note: The most recent health survey was on 08/12/2010.

Degree of Harm

- Potential for Minimal Harm
- Minimal Harm or Potential for Harm
- Resident Harmed
- Immediate Jeopardy to Resident Health

Residents Affected

- Isolated
- Some Residents
- Many Residents

Deficiencies Found By Inspectors

Degree of Harm

Residents Affected

Administration

1) Review the Work of Each Nurse Aide Every Year; or 2) Give Regular Training for the Nurse Aides. Inspection Date: 05/23/2008 Correction Date: 06/30/2008
Keep Accurate and Appropriate Medical Records. Inspection Date: 05/23/2008 Correction Date: 06/30/2008
Set Up or Keep a Group of People to Review and Ensure Quality. Inspection Date: 05/23/2008 Correction Date: 06/30/2008
Keep Accurate and Appropriate Medical Records. Inspection Date: 07/27/2009 Correction Date: 11/10/2009
Keep Accurate and Appropriate Medical Records. Inspection Date: 08/12/2010 Correction Date: 09/27/2010

Environmental

Provide Needed Housekeeping and Maintenance. Inspection Date: 05/23/2008 Correction Date: 06/30/2008
Make Sure That the Nursing Home Area is Safe, Easy to Use, Clean and Comfortable. Inspection Date: 05/23/2008 Correction Date: 06/30/2008
Keep All Essential Equipment Working Safely. Inspection Date: 08/12/2010 Correction Date: 09/27/2010
Make Sure There is a Program to Prevent/Deal with Mice, Insects, or Other Pests. Inspection Date: 08/12/2010 Correction Date: 09/27/2010

Nutrition and Dietary

Store, Cook, and Give out Food in a Safe and Clean Way. Inspection Date: 05/23/2008 Correction Date: 06/30/2008
Prepare Food That is Nutritional, Appetizing, Tasty, Attractive, Well-Cooked, and at the Right Temperature. Inspection Date: 08/12/2010 Correction Date: 09/27/2010
Store, Cook, and Give out Food in a Safe and Clean Way. Inspection Date: 08/12/2010 Correction Date: 09/27/2010

Pharmacy Service

Keep the Rate of Medication Errors (Wrong Drug, Wrong Dose, Wrong Time) to Less Than 5%. Inspection Date: 05/23/2008 Correction Date: 06/30/2008
Make Sure That Residents Are Safe from Serious Medication Errors. Inspection Date: 05/23/2008 Correction Date: 06/30/2008
1) Make Sure That Residents Who Take Drugs Are Not Given Too Many Doses or for Too Long; 2) Make Sure That the Use of Drugs is Carefully Watched; or 3) Stop or Change Drugs That Cause Unwanted Effects. Inspection Date: 07/27/2009 Correction Date: 11/10/2009
Have Drugs and Other Similar Products Available, Which Are Needed Every Day and in Emergencies, and Give Them out Properly. Inspection Date: 07/27/2009 Correction Date: 11/10/2009
At Least Once a Month, Have a Licensed Pharmacist Check the Drugs That Each Resident Takes. Inspection Date: 07/27/2009 Correction Date: 11/10/2009
Have Drugs and Other Similar Products Available, Which Are Needed Every Day and in Emergencies, and Give Them out Properly. Inspection Date: 08/12/2010 Correction Date: 09/27/2010
Properly Mark Drugs and Other Similar Products. Inspection Date: 08/12/2010 Correction Date: 09/27/2010

Quality Care

Make Sure That Each Resident's Nutritional Needs Were Met.

Inspection Date: 05/23/2008
Correction Date: 06/30/2008

Resident Assessment

Develop a Complete Care Plan That Meets All of a Resident's Needs, with Timetables and Actions That Can Be Measured.

Inspection Date: 07/27/2009
Correction Date: 11/10/2009

Resident Rights

Keep Each Resident's Personal and Medical Records Private and Confidential.

Inspection Date: 08/12/2010
Correction Date: 09/27/2010

Enforcement

Below is a list of any civil penalities or denials of payment for new admissions (DPNA) that this facility received in the previous three years. Note: Monetary figures are not available for DPNAs.

Action Taken	Date	Amount
Civil Money Penalty (CMP)	07/27/2009	$2,500
Denial of Payment for New Admission (DPNA)	07/27/2009	-

Deficiencies from Complaints and Incidents

The table below lists incident reports by the nursing staff or administration for Graham Oaks Care Center, as well as complaints by residents or their family in the previous three years.

Degree of Harm

- Potential for Minimal Harm
- Minimal Harm or Potential for Harm
- Resident Harmed
- Immediate Jeopardy to Resident Health

Residents Affected

- Isolated
- Some Residents
- Many Residents

Formal Complaints

Degree of Harm

Residents Affected