Inspection Reports for Angels Care
1905 S 17th St, Las Vegas, NV 89104, NV, 89104
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Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Census: 8
Capacity: 9
Deficiencies: 2
Jul 7, 2025
Visit Reason
This inspection was conducted as an annual State Licensure survey of the residential facility for groups, in accordance with Nevada Administrative Code Chapter 449.
Findings
The facility received a grade of A but had two regulatory deficiencies: failure to ensure annual inspection of fire extinguishers and failure to administer medication per physician's orders for one resident.
Severity Breakdown
2: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Fire extinguishers located in the common area and kitchen were not inspected within the past year. | 2 |
| Medication Donepezil 10 mg was not administered per physician's orders for Resident #7 from 07/01/2025 to 07/06/2025 due to failure to refill the prescription. | 2 |
Report Facts
Licensed beds: 9
Residents present: 8
Deficiencies cited: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cherry Daelto | Administrator | Named as facility administrator and signatory on the report |
Inspection Report
Annual Inspection
Census: 9
Capacity: 9
Deficiencies: 0
Jul 3, 2024
Visit Reason
This inspection was conducted as an annual State Licensure survey in accordance with Nevada Administrative Code Chapter 449 for Residential Facility for Groups.
Findings
The facility received a grade of A with no regulatory deficiencies identified during the survey. Nine resident files and four employee files were reviewed.
Report Facts
Resident files reviewed: 9
Employee files reviewed: 4
Inspection Report
Re-Inspection
Census: 8
Capacity: 9
Deficiencies: 18
Sep 14, 2023
Visit Reason
This inspection was a State Licensure mandatory grading resurvey conducted on 09/14/2023 to assess compliance with Nevada Administrative Code (NAC) Chapter 449 for a Residential Facility for Groups.
Findings
The facility received a grade of A. Several regulatory deficiencies were identified related to caregiver qualifications, personnel files, medication administration, safety from fire, medical care documentation, and infection control. The facility provided corrective actions for all deficiencies.
Severity Breakdown
D: 5
E: 6
F: 5
Deficiencies (18)
| Description | Severity |
|---|---|
| Qualifications of Caregivers - Age and Training requirements not fully met. | D |
| Qualifications of Caregiver - Medication Training requirements not met. | F |
| Elder Abuse Training requirements not met. | E |
| Personnel File - TB Screening documentation incomplete. | E |
| Personnel Files - Background Checks incomplete. | E |
| Personnel File - 1st Aid & CPR certification missing. | E |
| Requirements and Precautions regarding safety from fire not fully met. | F |
| Medical Care of Resident After Illness - Documentation incomplete. | D |
| Medication Administration - Accuracy and Report deficiencies. | E |
| Medication/OTCs, Supplements, Change Order procedures not fully followed. | E |
| Medication - Resident Refusal notification requirements not met. | D |
| Medication - Destruction procedures not fully followed. | E |
| Administration of Medication Maintenance and record keeping deficient. | F |
| Medication Storage unsecured; medication closet unlocked and medication left unattended in resident's room. | F |
| Maintenance and Contents of Separate Resident Files incomplete. | E |
| Care for Persons with Mental Illnesses - Training requirements not met. | D |
| Cultural Competency Training requirements not met. | D |
| Infection Control Program deficiencies noted. | F |
Report Facts
Licensed beds: 9
Census: 8
Severity 2 Deficiency: 1
Medication training hours: 16
Annual training hours: 8
Inspection Report
Annual Inspection
Census: 8
Capacity: 9
Deficiencies: 19
Jul 3, 2023
Visit Reason
Annual State Licensure survey conducted to assess compliance with Nevada Administrative Code Chapter 449 for a Residential Facility for Groups.
Findings
The facility was found deficient in multiple areas including caregiver training, medication management, personnel files, infection control, and safety compliance. Several repeat deficiencies from prior surveys were noted, and the facility received a grade of D.
Severity Breakdown
Level 2: 18
Deficiencies (19)
| Description | Severity |
|---|---|
| Failed to ensure 1 of 5 employees had eight hours of annual caregiver training. | Level 2 |
| Failed to ensure 1 of 5 caregivers had initial 16 hour medication management training and 4 of 5 caregivers had current eight hour annual medication management training. | Level 2 |
| Failed to ensure 2 of 6 employees had initial and/or annual elder abuse training. | Level 2 |
| Failed to ensure 3 of 6 employees had a pre-employment physical examination and/or two-step or annual Tuberculosis (TB) test. | Level 2 |
| Failed to ensure a background check was completed every five years for 1 of 6 employees and a Criminal History Statement was completed for 1 of 6 employees. | Level 2 |
| Failed to ensure 2 of 5 employees met the requirements for first aid and cardiopulmonary resuscitation (CPR) training. | Level 2 |
| Failed to ensure fire extinguishers, fire alarm, and sprinkler system were inspected annually. | Level 2 |
| Failed to ensure an annual physical examination was completed for 1 of 8 residents. | Level 2 |
| Failed to ensure residents received personal care required; Resident #1 was found soiled and uncared for. | Level 2 |
| Failed to ensure medication regimen reviews were completed for 2 of 8 residents. | Level 2 |
| Failed to ensure physician orders were obtained to clarify medication administration, medication was on site, and MAR matched prescription labels for 3 of 8 residents. | Level 2 |
| Failed to ensure physician was notified within 12 hours after a resident missed or refused medication for 1 of 8 residents. | Level 2 |
| Failed to ensure medications were destroyed properly for discontinued or expired medications and medications of discharged residents. | Level 2 |
| Failed to ensure Medication Administration Record was accurate for 5 of 8 residents. | Level 2 |
| Failed to ensure medications were stored securely; medications were found unsecured in multiple locations. | Level 2 |
| Failed to ensure 4 of 8 residents had required initial two-step or annual tuberculosis tests. | Level 2 |
| Failed to ensure 1 of 5 employees completed eight hours of mental illness training within 60 days of hire. | Level 2 |
| Failed to ensure 1 of 5 employees completed initial cultural competency training within 30 days of hire. | Level 2 |
| Failed to follow infection control policy; caregiver wore soiled mask and gloves outside resident room and did not perform hand hygiene. | Level 2 |
Report Facts
Licensed beds: 9
Residents present: 8
Employees reviewed: 5
Residents reviewed: 8
Severity 2 deficiencies: 18
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cherry Daelto | Administrator | Signed the report and mentioned in plan of correction monitoring |
| Employee #2 | Caregiver | Named in multiple findings including training deficiencies, medication management, personnel file issues, mental illness and cultural competency training |
| Employee #1 | Caregiver | Named in medication management and personnel file deficiencies |
| Employee #3 | Caregiver | Named in personnel file and elder abuse training deficiencies |
| Employee #4 | Caregiver | Named in medication management and CPR training deficiencies |
| Employee #5 | Caregiver | Named in medication management and CPR training deficiencies |
| Employee #6 | Administrator | Named in background check deficiency |
Inspection Report
Re-Inspection
Census: 7
Capacity: 9
Deficiencies: 6
Sep 13, 2022
Visit Reason
This inspection was a mandatory grading resurvey initiated at the facility on 09/13/22 in accordance with Nevada Administrative Code Chapter 449 for Residential Facility for Groups.
Findings
The facility received a grade of A. A regulatory deficiency was identified related to failure to ensure 3 of 5 employees received the required eight hours of annual medication training. Additional deficiencies were noted in personnel files regarding TB screening and background checks, written policy on admissions, and maintenance of resident files.
Severity Breakdown
Severity: F: 4
Severity: 2: 1
Severity: D: 1
Severity: E: 1
Deficiencies (6)
| Description | Severity |
|---|---|
| Failed to ensure 3 of 5 employees received eight hours of annual medication training. | Severity: 2 |
| Personnel files lacked required health certificates for employees. | Severity: F |
| Personnel files lacked evidence of background checks compliance. | Severity: F |
| Written policy on admissions did not meet requirements. | Severity: D |
| Maintenance and contents of separate resident files were deficient. | Severity: F |
| Caregivers did not receive required training related to care of elderly persons within 60 days of employment. | Severity: E |
Report Facts
Number of employees reviewed: 5
Number of resident files reviewed: 2
Number of beds licensed: 9
Census at time of survey: 7
Inspection Report
Annual Inspection
Census: 8
Capacity: 9
Deficiencies: 8
Jul 13, 2022
Visit Reason
The inspection was conducted as an annual State Licensure and infection control survey in accordance with Nevada Administrative Code (NAC) Chapter 449 for Residential Facility for Groups.
Findings
The facility was found deficient in multiple areas including caregiver medication training, elder abuse training, tuberculosis screening, background checks, admission policies, resident file security, caregiver training, and cultural competency training. The facility received a grade of D.
Severity Breakdown
Severity: 2: 8
Deficiencies (8)
| Description | Severity |
|---|---|
| Failed to ensure 3 of 5 employees received 16 hours medication training before assisting residents with medication administration. | Severity: 2 |
| Failed to ensure 3 of 5 employees received annual elder abuse training. | Severity: 2 |
| Failed to ensure 4 of 5 employees had a two-step and/or annual tuberculosis (TB) test or a physical examination. | Severity: 2 |
| Failed to ensure 3 of 5 employees had a signed disclosure statement, fingerprints, and a background check. | Severity: 2 |
| Failed to obtain an exemption request to retain a bedfast resident for 2 of 7 residents. | Severity: 2 |
| Failed to ensure resident files were secured; approximately 20 resident files were unsecured on a desk. | Severity: 2 |
| Failed to ensure 2 of 5 employees received four hours initial caregiver training within 60 days of employment. | Severity: 2 |
| Failed to submit or provide documented evidence of a cultural competency training program for employees. | Severity: 2 |
Report Facts
Deficiencies cited: 8
Census: 8
Total Capacity: 9
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cherry Daelto | Administrator | Signed the report as the facility administrator. |
Inspection Report
Annual Inspection
Census: 9
Capacity: 9
Deficiencies: 0
Sep 21, 2021
Visit Reason
The inspection was conducted as an annual state licensure and infection control survey in accordance with Nevada Administrative Code Chapter 449 for Residential Facility for Groups.
Findings
No regulatory deficiencies were identified during the survey. The facility received a grade of A and was provided guidance on nondiscrimination, privacy, cultural competency, and complaint policies.
Report Facts
Resident files reviewed: 9
Employee files reviewed: 5
Inspection Report
Abbreviated Survey
Census: 7
Capacity: 9
Deficiencies: 0
Oct 6, 2020
Visit Reason
The inspection was a focused COVID-19 infection control survey conducted to assess compliance with infection prevention measures in accordance with Nevada Administrative Code Chapter 449 for Residential Facilities for Groups.
Findings
The facility demonstrated adherence to COVID-19 screening, temperature checks, social distancing, and sanitization protocols. No residents or staff tested positive for COVID-19, and no deficiencies were identified during the inspection.
Report Facts
Hand sanitizer quantities: 3
Glove boxes: 4
Surgical mask boxes: 2
Gowns: 2
Face shields: 4
Residents present: 7
Licensed beds: 9
Inspection Report
Annual Inspection
Census: 7
Capacity: 9
Deficiencies: 0
Oct 15, 2019
Visit Reason
This inspection was conducted as an annual State licensure survey in accordance with Nevada Administrative Code Chapter 449 for Residential Facilities for Groups.
Findings
The facility was found to be in compliance with no regulatory deficiencies identified and received a grade of A. No further action was necessary.
Report Facts
Resident files reviewed: 7
Employee files reviewed: 3
Inspection Report
Annual Inspection
Census: 6
Capacity: 9
Deficiencies: 4
Nov 2, 2018
Visit Reason
The inspection was an annual State Licensure survey conducted to assess compliance with Nevada Administrative Code Chapter 449 for a Residential Facility for Groups.
Findings
The facility received a grade of A but was found deficient in health and sanitation hazards related to loose railings on a side exit door ramp, medication administration errors for two residents, failure to destroy discontinued medication for one resident, and failure to obtain an Alzheimer's endorsement for two residents.
Severity Breakdown
Level 2: 3
Deficiencies (4)
| Description | Severity |
|---|---|
| Facility failed to ensure a side exit door with a ramp had secure railings, posing a hazard to residents. | Level 2 |
| Facility failed to ensure medication orders were properly followed for 2 of 6 residents, including continued administration of discontinued medication. | Level 2 |
| Facility failed to ensure a resident's discontinued medication was destroyed as required. | Level 2 |
| Facility failed to obtain an Alzheimer's endorsement to provide care for 2 of 6 residents with Alzheimer's disease or related dementia. | — |
Report Facts
Deficiencies cited: 4
Census: 6
Total capacity: 9
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Manager | Acknowledged loose railings and medication errors during inspection. | |
| Caregiver | Acknowledged loose railings on side exit door ramp. |
Inspection Report
Annual Inspection
Census: 7
Capacity: 9
Deficiencies: 4
Nov 27, 2017
Visit Reason
This inspection was conducted as an annual State Licensure survey of the facility on 11/27/17 to assess compliance with state regulations for a Residential Facility for Group beds for elderly and disabled persons and/or persons with mental illness.
Findings
The facility received a grade of A but had several deficiencies including failure to ensure one employee met background check requirements, unsecured oxygen tanks in a resident's room, failure to administer medications as prescribed for two residents, and unsecured medication storage. Corrective actions were planned for each deficiency.
Severity Breakdown
Level 2: 4
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to ensure 1 of 5 employees met background check requirements; Employee #5 lacked proof of fingerprinting or background check. | Level 2 |
| Failed to secure eleven small oxygen tanks in the bedroom closet of Resident #3. | Level 2 |
| Failed to ensure medications were administered as prescribed for Residents #2 and #4; medications not given as ordered and medications not on site. | Level 2 |
| Failed to ensure medications were stored and secured in a locked area; Resident #3's Pro Air HFA inhaler was unsecured and lacked physician order for self-administration. | Level 2 |
Report Facts
Resident census: 7
Total licensed capacity: 9
Number of employee files reviewed: 5
Number of resident files reviewed: 7
Number of unsecured oxygen tanks: 11
Number of residents with medication deficiencies: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cherry Daelto | Administrator | Named as the Administrator who acknowledged deficiencies and signed the report |
Inspection Report
Complaint Investigation
Census: 7
Deficiencies: 1
Nov 15, 2016
Visit Reason
The inspection was conducted as a complaint investigation triggered by complaint #NV00047289 regarding failure to notify the physician of a resident's change of condition.
Findings
The investigation substantiated the allegation that the facility failed to notify the physician and guardian of a resident's fall incident in a timely manner. One complaint was substantiated, while another allegation of client abuse was not substantiated.
Complaint Details
Complaint #NV00047289 was substantiated. The allegation that the facility failed to notify the physician of a resident change of condition was substantiated. The allegation of client abuse by an employee was not substantiated.
Severity Breakdown
2: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility failed to ensure the physician and guardian of a resident were contacted at the time of an incident, specifically a fall on 10/23/16 where notification was delayed until the next day. | 2 |
Report Facts
Census: 7
Sample size: 5
Complaints investigated: 1
Severity level: 2
Scope: 1
Inspection Report
Re-Inspection
Census: 6
Capacity: 9
Deficiencies: 2
Jan 7, 2016
Visit Reason
This inspection was a mandatory State Licensure grading re-survey conducted on 01/07/16 to assess compliance with training and personnel file requirements.
Findings
The facility received a grade of A. Deficiencies were identified related to elder abuse training and background check documentation for employees. The facility failed to provide initial and annual elder abuse training for 2 of 4 employees and failed to ensure background checks met requirements for 1 of 4 employees. These were repeat deficiencies from the previous survey.
Severity Breakdown
Severity: 2: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to provide initial and annual elder abuse training to 2 of 4 employees. | Severity: 2 |
| Failure to ensure background check requirements were met for 1 of 4 employees. | Severity: 2 |
Report Facts
Census: 6
Total Capacity: 9
Employees reviewed: 4
Inspection Report
Renewal
Census: 6
Capacity: 9
Deficiencies: 2
Jan 7, 2016
Visit Reason
This inspection was a mandatory State Licensure grading re-survey conducted to assess compliance with state regulations for a Residential Facility for Group beds for elderly and disabled persons.
Findings
The facility received a grade of A but was found deficient in providing required elder abuse training to employees and in maintaining proper background check documentation for staff. These deficiencies were repeat findings from a prior survey.
Severity Breakdown
2: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to provide initial and annual training in the prevention, recognition and response to elder abuse to 2 of 4 employees. | 2 |
| Failed to ensure 1 of 4 employees met background check requirements, including timely State and FBI checks. | 2 |
Report Facts
Number of employees reviewed: 4
Number of deficiencies cited: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Employee #1 | Administrator | Named in findings for missing elder abuse training in 2015 and incomplete background checks |
| Employee #2 | Caregiver | Named in findings for missing initial elder abuse training prior to providing care |
| Employee #3 | Acknowledged missing documentation during inspection |
Inspection Report
Annual Inspection
Census: 8
Capacity: 9
Deficiencies: 11
Nov 3, 2015
Visit Reason
This document is a Statement of Deficiencies generated as a result of an annual State Licensure survey conducted on 11/3/15 to assess compliance with state regulations for a residential facility for elderly and disabled persons.
Findings
The facility was found deficient in multiple areas including caregiver medication training, elder abuse training, personnel file requirements (tuberculosis testing and background checks), health and sanitation, kitchen cleanliness, menu planning, physical examinations for residents, medication administration documentation, and resident file maintenance. Several deficiencies were repeats from the prior year's survey.
Severity Breakdown
Severity: 1: 3
Severity: 2: 8
Deficiencies (11)
| Description | Severity |
|---|---|
| Facility failed to ensure 1 of 3 employees completed required annual medication management training. | Severity: 2 |
| Facility failed to ensure 2 of 3 employees had timely completed initial elder abuse training. | Severity: 2 |
| Facility failed to ensure 1 of 3 employees met tuberculosis and pre-employment physical examination requirements. | Severity: 2 |
| Facility failed to ensure 1 of 3 employees had State and/or FBI background checks. | Severity: 2 |
| Facility failed to ensure the interior and exterior of the facility were clean and maintained. | Severity: 2 |
| Facility failed to ensure the kitchen and food preparation area were clean. | Severity: 2 |
| Facility failed to ensure a menu was planned, dated, and posted. | Severity: 1 |
| Facility failed to ensure 4 of 8 residents had a physical examination prior to admission and/or annual physical examination. | Severity: 2 |
| Facility failed to ensure an ultimate user agreement was on file for 8 of 8 residents' medications. | Severity: 2 |
| Facility failed to ensure 4 of 8 residents met tuberculosis testing requirements. | Severity: 2 |
| Facility failed to ensure rates for services were posted in a conspicuous place. | Severity: 1 |
Report Facts
Census: 8
Total Capacity: 9
Number of employees reviewed: 3
Number of resident files reviewed: 8
Inspection Report
Annual Inspection
Census: 8
Capacity: 9
Deficiencies: 11
Nov 3, 2015
Visit Reason
Annual State Licensure survey conducted to assess compliance with state regulations for a residential facility for elderly and disabled persons.
Findings
The facility received a grade of D with multiple deficiencies identified including failure to ensure required medication management training for employees, incomplete elder abuse training, missing tuberculosis and background check documentation, poor facility cleanliness and maintenance, inadequate kitchen sanitation, missing menus, incomplete resident physical exams, missing ultimate user medication agreements, and failure to post rates for services.
Severity Breakdown
1: 2
2: 9
Deficiencies (11)
| Description | Severity |
|---|---|
| Failed to ensure 1 of 3 employees completed required annual medication management training. | 2 |
| Failed to ensure 2 of 3 employees had timely completed initial elder abuse training. | 2 |
| Failed to ensure 1 of 3 employees met tuberculosis and pre-employment physical examination requirements. | 2 |
| Failed to ensure 1 of 3 employees had State and/or FBI background checks. | 2 |
| Facility interior and exterior were not clean or well maintained, including dirty chairs, cigarette butts, holes in ceiling, dust, dead insects, and lack of paper towels. | 2 |
| Kitchen and food preparation area were not clean, including stained cabinet liners, dead insects in oven, and dust on fan. | 2 |
| Failed to ensure a menu was planned, dated, and posted as required. | 1 |
| Failed to ensure 4 of 8 residents had physical examinations prior to admission and/or annual physical examinations. | 2 |
| Failed to ensure an ultimate user medication agreement was on file for all 8 residents. | 2 |
| Failed to ensure 4 of 8 residents met tuberculosis testing requirements. | 2 |
| Failed to post rates for services provided in a conspicuous place in the facility. | 1 |
Report Facts
Number of residents present: 8
Total licensed capacity: 9
Number of employee files reviewed: 3
Number of resident files reviewed: 8
Number of dead insects found: 15
Number of cigarette butts observed: 15
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Employee #1 | Named in multiple deficiencies including medication training, elder abuse training, TB and physical exam documentation, ultimate user agreement, and acknowledged findings | |
| Employee #2 | Named in multiple deficiencies including elder abuse training, TB and physical exam documentation, ultimate user agreement, and acknowledged findings | |
| Employee #3 | Named in background check deficiency |
Inspection Report
Complaint Investigation
Census: 7
Capacity: 9
Deficiencies: 3
Mar 6, 2015
Visit Reason
The inspection was conducted as a required grading re-survey and complaint investigation triggered by Complaint #NV00042137, which contained two allegations regarding employee to resident physical abuse and improper medication administration.
Findings
The complaint allegations were not substantiated. The facility received a grade of A. Deficiencies were identified related to health and sanitation hazards, maintenance of the premises, and medication administration practices, including unsecured oxygen tanks stored near flammable materials, broken glass and debris in the backyard, and failure to administer medication as prescribed by a physician.
Complaint Details
Complaint #NV00042137 contained two allegations: 1) Employee to resident physical abuse, which was not substantiated after investigation including resident observation, hospital records, and interviews; 2) Resident's medications were improperly administered, which was also not substantiated but deficiencies were found related to medication administration documentation.
Severity Breakdown
Severity: 2: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Facility failed to ensure the premises was free from hazards including unsecured oxygen tanks stored with flammable paints, cigarette butts scattered in the backyard, broken window glass, broken tiles, and other debris. | Severity: 2 |
| Facility failed to ensure the exterior premises was clean and well maintained, with uncovered trash cans, various equipment and items stored improperly, and dirty water buckets in the backyard. | Severity: 2 |
| Facility failed to ensure medications were administered as prescribed by a physician; Resident #1 was given Tramadol three times a day without a documented change order, contrary to the physician's order for as needed administration. | Severity: 2 |
Report Facts
Licensed beds: 9
Census: 7
Deficiencies cited: 3
Inspection Report
Complaint Investigation
Census: 7
Capacity: 9
Deficiencies: 3
Mar 6, 2015
Visit Reason
The inspection was conducted as a result of a required grading re-survey and complaint investigation at the facility on 3/6/15.
Findings
The facility received a grade of A. Two complaints were investigated regarding employee to resident physical abuse and improper medication administration; both allegations could not be substantiated. Deficiencies were identified related to health and sanitation hazards and medication administration.
Complaint Details
Complaint #NV00042137 contained two allegations: 1) Employee to resident physical abuse, which was not substantiated; 2) Resident's medications were improperly administered, which was also not substantiated.
Severity Breakdown
Severity: 2: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| The facility failed to keep the premises free from hazards including unsecured oxygen tanks, broken glass, cigarette butts, and other debris in the backyard. | Severity: 2 |
| The facility failed to ensure the exterior premises were clean and well maintained, with uncovered trash cans, scattered cigarette butts, dirty water buckets, and other items in the backyard. | Severity: 2 |
| The facility failed to ensure medications were administered as prescribed by a physician for one resident. | Severity: 2 |
Report Facts
Resident census: 7
Total capacity: 9
Severity 2 deficiencies: 3
Scope: 3
Scope: 1
Inspection Report
Annual Inspection
Census: 8
Capacity: 9
Deficiencies: 7
Dec 1, 2014
Visit Reason
This document is a Statement of Deficiencies generated as a result of an annual State Licensure survey conducted at the facility on 12/01/2014.
Findings
The facility was found deficient in multiple areas including caregiver qualifications, medication management training, personnel file requirements, health and sanitation, restraint definitions, and medication availability. The facility received a grade of C.
Severity Breakdown
Level 2: 7
Deficiencies (7)
| Description | Severity |
|---|---|
| Caregivers failed to meet qualifications to use a Hoyer lift; 2 of 5 employees were not qualified. | Level 2 |
| Three of five employees failed to complete 16 hours of medication management training. | Level 2 |
| Two of five employees did not receive required two-step tuberculosis screening and pre-employment physicals. | Level 2 |
| Two of five employees lacked completed criminal background checks. | Level 2 |
| Facility failed to maintain clean and well-maintained premises; backyard had refuse and broken items. | Level 2 |
| Resident was restrained by full bed rails, which is not permitted. | Level 2 |
| Medication was not on site for a resident; Novolog mix was missing from medication bin. | Level 2 |
Report Facts
Census: 8
Total Capacity: 9
Employees reviewed: 5
Resident files reviewed: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Employee #1 | Observed struggling with Hoyer lift use; lacked training | |
| Employee #4 | Observed struggling with Hoyer lift use; lacked training; was terminated on Dec 13, 2014 | |
| Employee #2 | Failed to complete required medication management training; has been an administrator since 2004 | |
| Employee #3 | Manager | Failed to complete medication management training and background check; terminated on Dec 8, 2014 |
| Employee #5 | Caregiver | Failed to complete medication management training and background check |
Inspection Report
Annual Inspection
Census: 8
Capacity: 9
Deficiencies: 7
Dec 1, 2014
Visit Reason
This annual State Licensure survey was conducted to assess compliance with regulatory requirements for the facility licensed for nine Residential Facility for Group beds for elderly and disabled persons and/or persons with mental illness.
Findings
The facility received a grade of C with multiple deficiencies identified including unqualified caregivers for Hoyer lift use, incomplete medication management training, missing tuberculosis screenings and background checks, accumulation of refuse in the backyard, improper use of full bed rails as restraints, and missing prescribed medication for a resident.
Severity Breakdown
Level 2: 7
Deficiencies (7)
| Description | Severity |
|---|---|
| Failed to ensure 2 of 5 employees were qualified to use a Hoyer lift. | Level 2 |
| Failed to ensure 3 of 5 employees completed 16 hours of medication management training. | Level 2 |
| Failed to ensure 2 of 5 employees received two-step tuberculosis screening and pre-employment physicals prior to employment. | Level 2 |
| Failed to ensure 2 of 5 employees had completed criminal background checks. | Level 2 |
| Failed to ensure the backyard was free from accumulation of refuse including broken furniture and unused items. | Level 2 |
| Failed to ensure a resident was not restrained by full bed rails. | Level 2 |
| Failed to ensure prescribed medication (Novolog mix 70/30) was on site for a resident. | Level 2 |
Report Facts
Deficiencies cited: 7
Facility licensed capacity: 9
Census at time of survey: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Employee #1 | Observed struggling with Hoyer lift use | |
| Employee #4 | Manager | Observed struggling with Hoyer lift use; acknowledged missing TB screening and background check documentation |
| Employee #2 | Administrator | Lacked documented evidence of 16 hours medication management training |
| Employee #3 | Manager | Lacked documented evidence of 16 hours medication management training; late TB screening and physical; missing background check |
| Employee #5 | Caregiver | Lacked documented evidence of 16 hours medication management training; missing background check |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 9
Deficiencies: 1
Apr 21, 2014
Visit Reason
The inspection was conducted as a complaint investigation initiated by the Bureau of Health Care Quality and Compliance on 4/21/14 regarding allegations of inappropriate level of care and lack of protective supervision.
Findings
The allegation of inappropriate level of care was not substantiated, but the allegation regarding lack of protective supervision was substantiated. The facility failed to provide appropriate supervision to one resident who left the facility unattended multiple times.
Complaint Details
Complaint #NV00038890 was investigated. The allegation regarding inappropriate level of care was not substantiated, but the allegation regarding lack of protective supervision was substantiated through record review, interviews with facility staff, and document review.
Severity Breakdown
Severity: 3: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility failed to provide appropriate supervision to 1 of 4 residents, who left the facility unattended on multiple occasions (Resident #4). | Severity: 3 |
Report Facts
Licensed capacity: 9
Census: 6
Sample size: 4
Severity level: 3
Scope: 1
Inspection Report
Complaint Investigation
Census: 6
Capacity: 9
Deficiencies: 1
Apr 21, 2014
Visit Reason
This inspection was conducted as a complaint investigation initiated by the Bureau of Health Care Quality and Compliance on 4/21/14 regarding allegations of inappropriate level of care and lack of protective supervision at the facility.
Findings
The allegation of inappropriate level of care was not substantiated; however, the allegation regarding lack of protective supervision was substantiated. The facility failed to provide appropriate supervision to one resident who left the facility unattended on multiple occasions, resulting in elopements.
Complaint Details
Complaint #NV00038890 was investigated. The allegation regarding inappropriate level of care was not substantiated, but the allegation regarding lack of protective supervision was substantiated based on record review, staff interviews, and document review.
Severity Breakdown
Severity: 3 Scope: 1: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility failed to provide appropriate protective supervision to 1 of 4 residents, who left the facility unattended on multiple occasions. | Severity: 3 Scope: 1 |
Report Facts
Licensed beds: 9
Resident census: 6
Sample size: 4
Elopement incidents: 3
Inspection Report
Annual Inspection
Census: 6
Capacity: 9
Deficiencies: 5
Dec 3, 2013
Visit Reason
The inspection was a State Licensure annual grading survey conducted to assess compliance with regulations for a residential facility for elderly and disabled persons.
Findings
The facility received a grade of B with several deficiencies identified including failure to ensure annual elder abuse training for employees, failure to ensure annual physical examinations for residents, and medication administration issues such as incomplete medication records and improper labeling.
Severity Breakdown
2: 5
Deficiencies (5)
| Description | Severity |
|---|---|
| Failure to ensure 3 of 4 employees received annual elder abuse training. | 2 |
| Failure to ensure 4 of 7 residents received an annual physical examination. | 2 |
| Failure to ensure 1 of 6 residents' medications were administered as prescribed. | 2 |
| Failure to ensure medication administration records (MAR) were accurate and complete for 3 of 6 MARs inspected. | 2 |
| Failure to ensure medications were plainly labeled for 2 of 6 residents. | 2 |
Report Facts
Census: 6
Total Capacity: 9
Employees reviewed: 4
Resident files reviewed: 6
Deficiencies cited: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Employee #1 | Administrator/Caregiver | Named in elder abuse training deficiency and medication administration findings |
| Employee #3 | Caregiver | Named in elder abuse training deficiency |
| Employee #4 | Caregiver | Named in elder abuse training deficiency |
Inspection Report
Annual Inspection
Census: 6
Capacity: 9
Deficiencies: 5
Dec 3, 2013
Visit Reason
This document is a State Licensure annual grading survey conducted to assess compliance with regulatory requirements for a Residential Facility for Group beds for elderly and disabled persons.
Findings
The facility received a grade of B with multiple deficiencies identified including failure to provide annual elder abuse training to employees, failure to ensure annual physical examinations for residents, medication administration errors, incomplete medication administration records, and improperly labeled medications.
Severity Breakdown
Level 2: 4
Level 3: 1
Deficiencies (5)
| Description | Severity |
|---|---|
| Administrator failed to ensure 3 of 4 employees received annual elder abuse training as required by Nevada Revised Statutes (NRS) 449.093. | Level 2 |
| Facility failed to ensure 4 of 7 residents received an annual physical examination as required. | Level 2 |
| Facility failed to ensure 1 of 6 residents received medications as prescribed, including incorrect dosage and frequency of Fentanyl patch. | Level 2 |
| Medication administration records (MAR) were inaccurate or incomplete for 3 of 6 residents, including incorrect documentation of medication dosage and administration instructions. | Level 3 |
| Medications were not plainly labeled with resident and physician names for 2 of 6 residents. | Level 2 |
Report Facts
Residents reviewed: 6
Employee files reviewed: 4
Facility licensed capacity: 9
Current census: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Employee #1 | Administrator/Caregiver | Named in elder abuse training deficiency and medication administration findings |
| Employee #3 | Caregiver | Named in elder abuse training deficiency |
| Employee #4 | Caregiver | Named in elder abuse training deficiency |
Inspection Report
Annual Inspection
Census: 7
Capacity: 9
Deficiencies: 3
Dec 18, 2012
Visit Reason
This inspection was conducted as an annual State Licensure survey to assess compliance with state regulations for a residential facility licensed for elderly or disabled persons and/or persons with mental illness.
Findings
The facility was found to have deficiencies related to admission policy regarding bedfast residents and medication administration, including failure to ensure residents received medications as prescribed and incomplete medication records. The facility received a grade of A.
Severity Breakdown
Level 2: 2
Level 1: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Facility retained a bedfast resident who was incapable of repositioning without assistance. | Level 2 |
| Failure to administer medications as prescribed for 4 of 7 residents. | Level 2 |
| Incomplete PRN medication records for 4 of 7 residents receiving as needed medications. | Level 1 |
Report Facts
Residents present: 7
Licensed beds: 9
Resident files reviewed: 7
Employee files reviewed: 4
Inspection Report
Annual Inspection
Census: 7
Capacity: 9
Deficiencies: 3
Dec 18, 2012
Visit Reason
The inspection was an annual State Licensure survey conducted to assess compliance with state regulations for a residential care facility.
Findings
The facility received a grade of A but had deficiencies including retaining a bedfast resident contrary to admission policy, failure to administer medications as prescribed for 4 of 7 residents, and incomplete medication records for 4 of 7 residents receiving PRN medications.
Severity Breakdown
Level 2: 2
Level 1: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Facility retained a resident who was bedfast, unable to reposition without assistance. | Level 2 |
| Failed to ensure 4 of 7 residents received medications as prescribed, including incorrect dosing schedules. | Level 2 |
| Medication records were incomplete for 4 of 7 residents receiving as needed (PRN) medications. | Level 1 |
Report Facts
Residents reviewed: 7
Employee files reviewed: 4
Facility licensed capacity: 9
Current census: 7
Residents with medication administration deficiencies: 4
Residents with incomplete medication records: 4
Inspection Report
Annual Inspection
Census: 8
Capacity: 9
Deficiencies: 2
Nov 30, 2011
Visit Reason
The inspection was an annual State Licensure survey conducted to assess compliance with regulations for a residential facility for elderly and disabled persons and/or persons with mental illness.
Findings
The facility received a grade of A. Two deficiencies were cited: one related to caregiver annual training where one of three caregivers did not receive the required 8 hours of training, and another related to the medication plan which failed to include all eight required components.
Severity Breakdown
E: 1
C: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| One of three caregivers failed to receive the required 8 hours of annual training. | E |
| The administrator failed to prepare a medication plan that included all eight required components. | C |
Report Facts
Number of caregivers reviewed: 3
Number of resident files reviewed: 8
Number of employee files reviewed: 3
Inspection Report
Annual Inspection
Census: 8
Capacity: 9
Deficiencies: 2
Nov 30, 2011
Visit Reason
The inspection was conducted as an annual State Licensure survey to assess compliance with regulatory standards for a residential facility for elderly and disabled persons and/or persons with mental illness.
Findings
The facility received a grade of A but had deficiencies including failure to ensure one caregiver received the required eight hours of annual training and failure to prepare a comprehensive medication plan including all required components. The caregiver training deficiency was a repeat from the prior year's survey.
Severity Breakdown
1: 1
2: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to ensure that 1 of 3 caregivers received eight hours of annual training (Employee #3). | 2 |
| Failed to prepare a medication plan that included all eight required components. | 1 |
Report Facts
Number of caregivers reviewed: 3
Number of resident files reviewed: 8
Number of employee files reviewed: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Employee #3 | Named in caregiver training deficiency |
Inspection Report
Complaint Investigation
Capacity: 9
Deficiencies: 0
Sep 29, 2011
Visit Reason
This Statement of Deficiencies was generated as a result of a complaint investigation conducted at the facility from 2011-01-13 to 2011-09-29. The investigation was initiated by the Bureau of Health Care Quality and Compliance regarding allegations about facility staff opening residents' mail, increasing residents' monthly fees without refunding rent, and not allowing a friend to take a resident to a medical appointment.
Findings
The complaint allegations were not substantiated. Interviews with facility staff and residents, review of facility policies, resident agreements, and administrator statements supported that employees did not open residents' mail, monthly fees were properly documented and no refunds were due, and residents were taken to medical appointments by authorized persons without restriction on friends accompanying them.
Complaint Details
Complaint #NV00026896 was not substantiated. Allegations regarding staff opening residents' mail, increasing monthly fees without refund, and restricting friends from taking residents to medical appointments were investigated and found unsubstantiated based on interviews, policy reviews, and resident agreements.
Report Facts
Licensed capacity: 9
Complaint investigation period: 258
Inspection Report
Annual Inspection
Census: 5
Capacity: 9
Deficiencies: 5
Nov 30, 2010
Visit Reason
This document is the result of an annual State Licensure survey conducted at the facility on 11/30/2010 to assess compliance with regulatory requirements.
Findings
The facility received a grade of B and was found deficient in several areas including caregiver training, personnel background checks, facility cleanliness, medication administration, and resident file maintenance.
Severity Breakdown
2: 4
1: 1
Deficiencies (5)
| Description | Severity |
|---|---|
| Caregiver failed to receive the required 8 hours of annual training. | 2 |
| Personnel files lacked required background checks for 2 of 3 employees. | 2 |
| Facility premises were not clean and well maintained, including dirty ceiling vents and lint/clothing behind dryer. | 1 |
| Medication prescribed was not available as documented for one resident. | 2 |
| Resident file did not comply with tuberculosis testing requirements. | 2 |
Report Facts
Deficiencies cited: 5
Census: 5
Total capacity: 9
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Employee #1 | Failed to have completed FBI and State background checks as of 11/30/10 | |
| Employee #2 | Failed to receive 8 hours of annual training and stated only giving generic ear wax medication PRN |
Inspection Report
Annual Inspection
Census: 5
Capacity: 9
Deficiencies: 5
Nov 30, 2010
Visit Reason
This document is a Statement of Deficiencies generated as a result of an annual State Licensure survey conducted at the facility on 11/30/2010 to assess compliance with state regulations for a residential facility for elderly and disabled persons and/or persons with mental illness.
Findings
The facility received a grade of B and was found deficient in several areas including caregiver training, employee background checks, facility cleanliness and maintenance, medication administration, and resident tuberculosis testing compliance. Some deficiencies were repeat findings from a prior survey.
Severity Breakdown
2: 5
Deficiencies (5)
| Description | Severity |
|---|---|
| Failed to ensure that 1 of 3 caregivers received eight hours of annual training (Employee #2). | 2 |
| Failed to ensure 2 of 3 employees met background check requirements (Employee #1 no State or FBI background checks, and Employee #2 outdated background checks). This was a repeat deficiency. | 2 |
| Failed to ensure the premises was clean and well maintained (dirty ceiling vents, lint and clothing behind dryer, loose cable wire). | 2 |
| Facility lacked medications as prescribed for 1 of 5 residents (Resident 4's Carbamide Peroxide 6.5% documented as given 4x daily but not available; only generic ear wax medication given 2x daily). | 2 |
| Failed to ensure 1 of 5 residents complied with tuberculosis testing requirements (Resident #3 had outdated TB test). This was a repeat deficiency. | 2 |
Report Facts
Licensed beds: 9
Residents present: 5
Employees reviewed: 3
Resident files reviewed: 5
Repeat deficiencies: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Employee #1 | Named in background check deficiency for lacking State or FBI background checks | |
| Employee #2 | Named in caregiver training deficiency and medication administration deficiency |
Inspection Report
Re-Inspection
Census: 5
Capacity: 6
Deficiencies: 4
Mar 9, 2010
Visit Reason
The inspection was conducted as a required grading re-survey, a bed increase survey, and a category change survey for the facility.
Findings
The facility received a re-survey grade of A. Several regulatory deficiencies were identified including failure to ensure tuberculosis testing compliance for one employee, improper medication storage and container use for one resident, and failure to keep resident files locked.
Severity Breakdown
Level 2: 3
Level 1: 1
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to ensure 1 of 4 employees complied with tuberculosis testing requirements. | Level 2 |
| Failed to ensure medications for 1 of 5 residents were kept in a locked area. | Level 2 |
| Failed to keep medications for 1 of 5 residents in their original container. | Level 2 |
| Failed to ensure 6 of 6 resident files were kept in a locked place. | Level 1 |
Report Facts
Licensed beds: 6
Current census: 5
Additional beds requested: 3
Employees reviewed for TB compliance: 4
Residents observed for medication storage: 5
Resident files observed: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Employee #1 | Named in tuberculosis testing deficiency |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 7
Dec 3, 2009
Visit Reason
This document is a Statement of Deficiencies generated as a result of an annual State Licensure survey conducted at Angels Care on 12/3/2009 to assess compliance with state regulations for a residential facility for elderly and disabled persons.
Findings
The facility was found to have multiple deficiencies including failure to ensure tuberculosis testing compliance for employees and residents, incomplete background checks, lack of first aid and CPR certification for caregivers, malfunctioning emergency lighting, improper bathroom ventilation, and improper medication administration for a diabetic resident. Several deficiencies were repeat findings from the previous year's survey.
Severity Breakdown
Level 2: 6
Level 3: 1
Deficiencies (7)
| Description | Severity |
|---|---|
| Failed to ensure 2 of 4 employees complied with tuberculosis testing requirements (no pre-employment physicals on file). | Level 2 |
| Failed to ensure 1 of 4 caregivers met background check requirements. | Level 2 |
| Failed to ensure 1 of 4 caregivers were trained in first aid and CPR. | Level 2 |
| Failed to ensure 1 of 2 emergency lights functioned when tested. | Level 2 |
| Failed to ensure 1 of 2 bathrooms were properly vented. | Level 2 |
| Failed to ensure 1 of 5 residents receiving insulin administered the medication themselves without assistance. | Level 3 |
| Failed to ensure 1 of 5 residents complied with tuberculosis testing (second step TB test not completed). | Level 2 |
Report Facts
Residents present: 5
Total licensed capacity: 6
Employees reviewed: 4
Resident files reviewed: 5
Discharged resident files reviewed: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Employee #1 | Failed tuberculosis testing compliance | |
| Employee #2 | Administrator | Failed tuberculosis testing compliance; prepared prefilled insulin syringes |
| Employee #3 | Failed background check requirements | |
| Employee #4 | Interviewed regarding insulin administration and medication storage | |
| Resident #1 | Diabetic resident receiving insulin injections | |
| Resident #2 | Resident with incomplete tuberculosis testing |
Inspection Report
Annual Inspection
Census: 3
Capacity: 6
Deficiencies: 14
Dec 5, 2008
Visit Reason
This annual state licensure survey was conducted to assess compliance with Nevada Administrative Code (NAC) 449 for Residential Facilities for Groups, including review of resident records, personnel files, and facility conditions.
Findings
The survey identified multiple regulatory deficiencies including failure to maintain staffing schedules, incomplete personnel files, lack of current first aid and CPR certifications, failure to conduct monthly emergency drills and smoke detector checks, medication administration errors, and incomplete documentation related to hospice care and incident reporting.
Severity Breakdown
Level 1: 2
Level 2: 10
Level 3: 1
Deficiencies (14)
| Description | Severity |
|---|---|
| Failure to maintain a written staffing schedule for six months. | Level 1 |
| Incomplete personnel files lacking health certificates, physical exams, TB screening, background checks, and fingerprints for employees. | Level 2 |
| Personnel files missing current first aid and CPR certifications for employees. | Level 2 |
| Failure to perform and document monthly emergency evacuation drills for the past year. | Level 2 |
| Failure to perform and document monthly smoke detector checks for the past year. | Level 2 |
| Failure to obtain physician's order before administering over-the-counter medications for some residents. | Level 2 |
| Failure to administer medications according to physician's orders for 2 of 3 residents. | Level 2 |
| Failure to maintain accurate medication administration records (MAR) including exact number of tablets given and purpose of medications. | Level 2 |
| Failure to store medication in a locked container in resident's room. | Level 2 |
| Failure to obtain and maintain a copy of the hospice plan of care for a resident receiving hospice services. | Level 1 |
| Failure to submit a hospice waiver request for a resident admitted to hospice within a week. | Level 2 |
| Failure to notify physician or family after an injury to a resident and incomplete incident report documentation. | Level 2 |
| Failure to properly document administration of as-needed (PRN) medications for 2 of 3 residents. | Level 2 |
| Medication administration record lacked documentation of results for a medication given regularly. | Level 3 |
Report Facts
Licensed beds: 6
Resident census: 3
Deficiency count: 13
Inspection Report
Annual Inspection
Census: 3
Capacity: 6
Deficiencies: 12
Dec 5, 2008
Visit Reason
The inspection was conducted as the annual state licensure survey for the residential facility Angels Care, to assess compliance with Nevada Administrative Code (NAC) 449 Residential Facility for Groups Regulations.
Findings
The facility was found to have multiple deficiencies including failure to maintain staffing schedules, incomplete personnel files, missing emergency drill and smoke detector records, improper medication administration and storage, lack of hospice care plan, failure to notify physician/family after injury, and inadequate documentation of PRN medication administration.
Severity Breakdown
Level 1: 2
Level 2: 8
Level 3: 1
Deficiencies (12)
| Description | Severity |
|---|---|
| Failed to maintain a written staffing schedule and retain schedules for six months. | Level 1 |
| Failed to maintain complete personnel files with all required documents for 2 of 2 employees, including health certificates, background checks, and first aid/CPR certification. | Level 2 |
| Failed to ensure emergency evacuation drills were performed monthly for the past year. | Level 2 |
| Failed to ensure smoke detector checks were completed monthly for the past year. | Level 2 |
| Failed to obtain physician's order before administering over-the-counter medications and failed to document administration for 1 of 3 residents. | Level 2 |
| Failed to administer medications according to physician's orders for 2 of 3 residents. | Level 2 |
| Failed to maintain instructions for administering medication reflecting current physician orders for 2 of 3 residents. | Level 2 |
| Failed to ensure medication was kept in a locked container in the room of 1 of 3 residents. | Level 2 |
| Failed to obtain a copy of the hospice plan of care for 1 of 3 residents receiving hospice care. | Level 1 |
| Failed to submit a hospice waiver request for 1 of 3 residents. | Level 2 |
| Failed to notify family or physician after an injury for 1 of 3 residents. | Level 2 |
| Failed to properly document administration of as needed (PRN) medications for 2 of 3 residents, including reason, results, and caregiver initials. | Level 3 |
Report Facts
Licensed beds: 6
Residents present: 3
Employees reviewed: 2
Resident records reviewed: 3
Closed resident records reviewed: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Employee #1 | Administrator | Named in deficiencies related to incomplete personnel files, missing health certificates, background checks, and first aid/CPR certification |
| Employee #2 | Caregiver | Named in deficiencies related to incomplete personnel files, missing health certificates, background checks, first aid/CPR certification, medication administration, emergency drill and smoke detector record keeping, and failure to notify physician/family after injury |
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