Deficiency Records for Mountain Meadows Health and Rehabilitation
Updated as of April 01, 2024
A list of the most recent deficiencies for Mountain Meadows Health and Rehabilitation. The list is based on the information provided by CMS from both standard inspections and from complaints filed by residents.
| Deficiency | Type of Deficiency | Deficiency Date | Date Corrected | Resulted from a Complaint? |
|---|---|---|---|---|
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-04-06 | 2023-04-26 | N |
| Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. | Health | 2023-04-06 | 2023-04-26 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-04-06 | 2023-04-26 | N |
| Keep residents' personal and medical records private and confidential. | Health | 2022-02-10 | 2022-03-10 | N |
| Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. | Health | 2022-02-10 | 2022-03-10 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-02-10 | 2022-03-10 | N |
| Provide appropriate foot care. | Health | 2022-02-10 | 2022-03-10 | N |
| Provide timely, quality laboratory services/tests to meet the needs of residents. | Health | 2022-02-10 | 2022-03-10 | N |
| Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector. | Fire Safety | 2022-02-07 | 2022-03-10 | N |
| Have exits that are accessible at all times. | Fire Safety | 2022-02-07 | 2022-03-10 | N |
| Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. | Fire Safety | 2022-02-07 | 2022-03-10 | N |
| Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. | Health | 2021-04-23 | 2021-04-26 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2020-11-12 | 2020-12-11 | N |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2020-11-12 | 2020-12-11 | N |
| Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. | Health | 2020-11-12 | 2020-12-11 | N |
| Keep residents' personal and medical records private and confidential. | Health | 2020-11-12 | 2020-12-11 | N |
| Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. | Health | 2020-11-12 | 2020-12-11 | N |
| Protect each resident from the wrongful use of the resident's belongings or money. | Health | 2020-11-12 | 2020-12-11 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2020-11-12 | 2020-12-11 | N |
| Respond appropriately to all alleged violations. | Health | 2020-11-12 | 2020-12-11 | N |
| Ensure each resident receives an accurate assessment. | Health | 2020-11-12 | 2020-12-11 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2020-11-12 | 2020-12-11 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2020-11-12 | 2020-12-11 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2020-11-12 | 2020-12-11 | N |
| Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. | Health | 2020-11-12 | 2020-12-11 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2020-11-12 | 2020-12-11 | N |
| Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. | Health | 2020-11-12 | 2020-12-11 | N |
| Provide for the safe, appropriate administration of IV fluids for a resident when needed. | Health | 2020-11-12 | 2020-12-11 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2020-11-12 | 2020-12-11 | N |
| Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. | Health | 2020-11-12 | 2020-12-11 | N |
| Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. | Health | 2020-11-12 | 2020-12-11 | N |
| Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. | Health | 2020-11-12 | 2020-12-11 | N |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2020-11-12 | 2020-12-11 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2020-11-12 | 2020-12-11 | N |
| Provide and implement an infection prevention and control program. | Health | 2020-11-12 | 2020-12-11 | N |
| Make sure that a working call system is available in each resident's bathroom and bathing area. | Health | 2020-11-12 | 2020-12-11 | N |
| Have an alternate power supply for its alarm system. | Fire Safety | 2020-11-04 | 2020-12-08 | N |
