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Inspection Detail
Inspection: 125755983 - Evergreen To Louisiana Nursing Home
Inspection Information - Office: American Canyon District Office
Site Address:
Evergreen To Louisiana Nursing Home
1101 Louisiana St.
Vallejo, CA 94591
Mailing Address:
, , 00000
Union Status: NonUnion
SIC:8051
NAICS: 623110/Nursing Care Facilities
Inspection Type: Accident
Scope: Partial
Advanced Notice: N
Ownership: Private
Safety/Health: Health
Close Conference: 03/30/2004
Emphasis:
Case Closed: 07/13/2006
| Type | Activity Nr | Safety | Health |
|---|---|---|---|
| Accident | 362344970 |
| Violations/Penalties | Serious | Willful | Repeat | Other | Unclass | Total |
|---|---|---|---|---|---|---|
| Initial Violations | 2 | 2 | ||||
| Current Violations | 2 | 2 | ||||
| Initial Penalty | $0 | $0 | $0 | $935 | $0 | $935 |
| Current Penalty | $0 | $0 | $0 | $935 | $0 | $935 |
| FTA Penalty | $0 | $0 | $0 | $0 | $0 | $0 |
| # | Citation ID | Citaton Type | Standard Cited | Issuance Date | Abatement Due Date | Current Penalty | Initial Penalty | FTA Penalty | Contest | Latest Event | Note |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. | 01001 | Other | 5193 C01 A | 05/13/2004 | 06/30/2004 | $750 | $750 | $0 | - | ||
| 2. | 01002 | Other | 3203 A | 05/13/2004 | 06/30/2004 | $185 | $185 | $0 | - |
Investigation Summary
At approximately 3:15 p.m. on December 28, 2003, Employee #1, a nurse, heard an alarm indicating that a patient needed assistance. The employee went to the patient's bedside, turned the alarm off and assisted the patient. When the Employee #1 turned to leave the bedside, her foot was tangled in tubing that ran from an oxygen machine to the patient. She fell and fractured her hip.
Keywords: FRACTURE, HEALTH CARE WORKER, HOSE, TRIPPED, FALL, HIP
| # | Inspection | Age | Sex | Degree of Injury | Nature of Injury | Occupation |
|---|---|---|---|---|---|---|
| 1 | 125755983 | Hospitalized injury | Fracture | Registered nurses |