A list of the most recent deficiencies for Oakwood Gardens Care Center. 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? |
|---|---|---|---|---|
| Conduct testing and exercise requirements. | Fire Safety | 2023-03-02 | 2023-03-20 | N |
| Use approved construction type or materials. | Fire Safety | 2023-03-02 | 2023-03-20 | N |
| Have properly located and lighted "Exit" signs. | Fire Safety | 2023-03-02 | 2023-03-20 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2023-03-02 | 2023-03-20 | N |
| Properly provide smoke detection systems in areas open to corridors. | Fire Safety | 2023-03-02 | 2023-03-20 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-03-02 | 2023-03-20 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2023-03-02 | 2023-03-20 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2023-03-02 | 2023-03-20 | N |
| Provide a written emergency evacuation plan. | Fire Safety | 2023-03-02 | 2023-03-20 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2023-03-02 | 2023-03-20 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-03-02 | 2023-03-20 | N |
| Meet requirements for the use of electrical equipment. | Fire Safety | 2023-03-02 | 2023-03-20 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2023-03-02 | 2023-03-20 | N |
| Ensure that residents are fully informed and understand their health status, care and treatments. | Health | 2023-02-17 | 2023-03-18 | N |
| Ensure each resident receives an accurate assessment. | Health | 2023-02-17 | 2023-03-18 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-02-17 | 2023-03-18 | N |
| Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | Health | 2023-02-17 | 2023-03-18 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2023-02-17 | 2023-03-18 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2023-02-17 | 2023-03-18 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2023-02-17 | 2023-03-18 | 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 | 2023-02-17 | 2023-03-18 | N |
| Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. | Health | 2023-02-17 | 2023-03-18 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-02-17 | 2023-03-18 | N |
| Ensure the facility is licensed under applicable State and local law and operates and provides services in compliance with all applicable Federal, State, and local laws, regulations, and codes, and with accepted professional standards. | Health | 2023-02-17 | 2023-03-18 | N |
| Ensure resident rooms hold no more than 4 residents; for new construction after November 28, 2016, rooms hold no more than 2 residents. | Health | 2023-02-17 | 2023-03-18 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-08-22 | 2022-09-26 | N |
| Implement a program that monitors antibiotic use. | Health | 2022-08-22 | 2022-09-26 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-08-22 | 2022-09-26 | Y |
| Provide and implement an infection prevention and control program. | Health | 2022-01-19 | 2022-02-11 | N |
| Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. | Health | 2021-06-30 | 2021-07-12 | Y |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2020-03-05 | 2020-11-24 | N |
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2020-03-05 | 2020-11-24 | N |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2020-03-05 | 2020-11-24 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2020-03-05 | 2020-11-24 | N |
| Have a policy regarding use and storage of foods brought to residents by family and other visitors. | Health | 2020-03-05 | 2020-11-24 | N |
| Ensure resident rooms hold no more than 4 residents; for new construction after November 28, 2016, rooms hold no more than 2 residents. | Health | 2020-03-05 | 2020-11-24 | N |
| Make sure that a working call system is available in each resident's bathroom and bathing area. | Health | 2020-03-05 | 2020-11-24 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2020-08-12 | 2020-08-31 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2020-08-12 | 2020-08-31 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2020-08-12 | 2020-08-31 | N |
| Assure that each resident?s assessment is updated at least once every 3 months. | Health | 2019-03-01 | 2019-04-23 | N |
| Ensure each resident receives an accurate assessment. | Health | 2019-03-01 | 2019-04-23 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2019-03-01 | 2019-04-23 | N |
| Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | Health | 2019-03-01 | 2019-04-23 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2019-03-01 | 2019-04-23 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2019-03-01 | 2019-04-23 | N |
| Provide and implement an infection prevention and control program. | Health | 2019-03-01 | 2019-04-23 | N |
| Ensure resident rooms hold no more than 4 residents; for new construction after November 28, 2016, rooms hold no more than 2 residents. | Health | 2019-03-01 | 2019-04-23 | N |
| Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2019-03-28 | 2019-04-17 | 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 | 2019-03-28 | 2019-04-17 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2019-03-28 | 2019-04-17 | N |
| Have properly located and lighted "Exit" signs. | Fire Safety | 2019-03-28 | 2019-04-17 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2019-03-28 | 2019-04-17 | N |
| Have power receptacles that are properly grounded. | Fire Safety | 2019-03-28 | 2019-04-17 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2019-03-28 | 2019-04-17 | N |
