Deficiency Records for Brier Oak On Sunset
Updated as of May 01, 2022
This is not the most recent data for Brier Oak On Sunset. For the most recent information, click here.
A list of the most recent deficiencies for Brier Oak On Sunset. 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? |
|---|---|---|---|---|
| Provide or get specialized rehabilitative services as required for a resident. | Health | 2022-03-04 | 2022-03-16 | Y |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2022-02-12 | 2022-02-28 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2022-02-12 | 2022-02-28 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2022-01-17 | 2022-01-31 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-01-04 | 2022-01-28 | Y |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2021-09-30 | 2021-10-13 | Y |
| Ensure that residents are free from significant medication errors. | Health | 2021-08-07 | 2021-08-18 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2021-05-14 | 2021-05-27 | Y |
| Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | Health | 2021-04-18 | 2021-04-27 | Y |
| Ensure that residents are free from significant medication errors. | Health | 2021-04-13 | 2021-04-23 | Y |
| 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 | 2021-01-30 | 2021-02-25 | Y |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2020-11-13 | 2020-12-03 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2020-11-13 | 2020-12-03 | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2020-11-05 | 2020-11-17 | Y |
| Let each resident or the resident's legal representative access or purchase copies of all the resident's records. | Health | 2020-08-01 | 2020-08-13 | Y |
| Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | Health | 2020-05-29 | 2020-06-10 | Y |
| Plan the resident's discharge to meet the resident's goals and needs. | Health | 2020-04-07 | 2020-05-06 | Y |
| Plan the resident's discharge to meet the resident's goals and needs. | Health | 2020-02-12 | 2020-03-07 | Y |
| 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 | 2020-01-30 | 2020-02-10 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2019-12-10 | 2019-12-24 | Y |
| Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. | Health | 2019-11-13 | 2019-12-04 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2019-10-11 | 2019-10-21 | Y |
| Address patient/client population and determine types of services needed. | Fire Safety | 2019-09-18 | 2019-10-11 | N |
| Provide rooms that can be unlocked from inside without a key. | Fire Safety | 2019-09-18 | 2019-10-11 | N |
| Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements. | Fire Safety | 2019-09-18 | 2019-10-11 | N |
| Install proper backup exit lighting. | Fire Safety | 2019-09-18 | 2019-10-11 | 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 | 2019-09-18 | 2019-10-11 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2019-09-18 | 2019-10-11 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2019-09-18 | 2019-10-11 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2019-09-18 | 2019-10-11 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2019-09-18 | 2019-10-11 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2019-09-10 | 2019-10-04 | N |
| Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. | Health | 2019-09-10 | 2019-10-04 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2019-09-10 | 2019-10-04 | 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 | 2019-09-10 | 2019-10-04 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2019-09-10 | 2019-10-04 | N |
| Provide and implement an infection prevention and control program. | Health | 2019-09-10 | 2019-10-04 | N |
| Provide medically-related social services to help each resident achieve the highest possible quality of life. | Health | 2019-08-28 | 2019-09-12 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2019-08-01 | 2019-08-12 | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2019-07-09 | 2019-07-25 | Y |
| List the names and contact information of those in the facility. | Fire Safety | 2018-09-28 | 2018-10-28 | N |
| Provide emergency officials' contact information. | Fire Safety | 2018-09-28 | 2018-10-28 | N |
| Conduct testing and exercise requirements. | Fire Safety | 2018-09-28 | 2018-10-28 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2018-09-28 | 2018-10-28 | N |
| Install a fire alarm system that can be heard throughout the facility. | Fire Safety | 2018-09-28 | 2018-10-28 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2018-09-28 | 2018-10-28 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2018-09-28 | 2018-10-28 | N |
| Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. | Health | 2018-09-27 | 2018-10-27 | N |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2018-09-27 | 2018-10-27 | N |
| Honor the resident's right to organize and participate in resident/family groups in the facility. | Health | 2018-09-27 | 2018-10-27 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2018-09-27 | 2018-10-27 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2018-09-27 | 2018-10-27 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2018-09-27 | 2018-10-27 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2018-09-27 | 2018-10-27 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2018-09-27 | 2018-10-27 | 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 | 2018-09-27 | 2018-10-27 | N |
| Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. | Health | 2018-09-27 | 2018-10-27 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2018-09-27 | 2018-10-27 | N |
| Allow residents to self-administer drugs if determined safe. | Health | 2017-02-28 | 2017-08-23 | N |
| Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2017-02-28 | 2017-08-23 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2017-02-28 | 2017-08-23 | N |
| Provide necessary care and services to maintain or improve the highest well being of each resident . | Health | 2017-02-28 | 2017-08-23 | N |
| Assist those residents who need help with eating/drinking, grooming and personal and oral hygiene. | Health | 2017-02-28 | 2017-08-23 | N |
| Ensure that each resident who enters the nursing home without a catheter is not given a catheter, unless medically necessary, and that incontinent patients receive proper services to prevent urinary tract infections and restore normal bladder functions. | Health | 2017-02-28 | 2017-08-23 | N |
| Ensure that residents with limited range of motion receive appropriate treatment and services to increase range of motion or prevent further decrease in range of motion. | Health | 2017-02-28 | 2017-08-23 | N |
| Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. | Health | 2017-02-28 | 2017-08-23 | N |
| Provide routine and emergency drugs through a licensed pharmacist and only under the general supervision of a licensed nurse. | Health | 2017-02-28 | 2017-08-23 | N |
| Set up an ongoing quality assessment and assurance group to review quality deficiencies quarterly, and develop corrective plans of action. | Health | 2017-02-28 | 2017-08-23 | N |
| Keep residents' personal and medical records private and confidential. | Health | 2017-02-28 | 2017-08-09 | N |
| Store, cook, and serve food in a safe and clean way. | Health | 2017-02-28 | 2017-08-09 | N |
| Protect each resident from mistreatment, neglect and misappropriation of personal property. | Health | 2017-02-28 | 2017-05-26 | N |
| Properly care for residents needing special services, including: injections, colostomy, ureostomy, ileostomy, tracheostomy care, tracheal suctioning, respiratory care, foot care, and prostheses. | Health | 2017-02-28 | 2017-05-26 | N |
| Have a program that investigates, controls and keeps infection from spreading. | Health | 2017-02-28 | 2017-05-26 | N |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2017-02-28 | 2017-05-23 | N |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2017-02-28 | 2017-05-23 | N |
| Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. | Health | 2017-02-28 | 2017-05-23 | 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 | 2017-03-02 | 2017-03-28 | 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 | 2017-03-02 | 2017-03-28 | N |
| Properly install and monitor supervisory attachments on automatic sprinkler systems. | Fire Safety | 2017-03-02 | 2017-03-28 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2017-03-02 | 2017-03-28 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2017-03-02 | 2017-03-28 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2017-03-02 | 2017-03-28 | N |
| Have a battery powered remote alarm panel in a location accessible by operating personnel. | Fire Safety | 2017-03-02 | 2017-03-28 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2017-03-02 | 2017-03-28 | N |
| Meet other general requirements. | Fire Safety | 2017-03-02 | 2017-03-28 | N |
| Ensure that residents are fully informed and understand their health status, care and treatments. | Health | 2017-02-28 | 2017-03-26 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2017-02-28 | 2017-03-26 | N |
| Permit residents to remain in the facility and not be transferred or discharged without adequate reason. | Health | 2017-02-28 | 2017-03-26 | N |
| Develop and implement policies for 1) screening and training employees; and the 2) prevention, identification, investigation, and reporting of any abuse, neglect, mistreatment and misappropriation of property. | Health | 2017-02-28 | 2017-03-26 | N |
| Provide care for residents in a way that maintains or improves their dignity and respect in full recognition of their individuality. | Health | 2017-02-28 | 2017-03-26 | N |
| Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. | Health | 2017-02-28 | 2017-03-26 | N |
| Ensure residents maintain acceptable nutritional status. | Health | 2017-02-28 | 2017-03-26 | N |
| Ensure that each resident's 1) entire drug/medication regimen is free from unnecessary drugs; and 2) is managed and monitored to achieve highest level of well-being. | Health | 2017-02-28 | 2017-03-26 | N |
| Provide a tasty and well-balanced diet that meets the nutritional needs of each resident. | Health | 2017-02-28 | 2017-03-26 | N |
| Provide food in a way that meets a resident's needs. | Health | 2017-02-28 | 2017-03-26 | N |
| 1) Provide 3 meals at regular times; 2) serve breakfast within 14 hours of dinner; and 3) offer a snack at bedtime each day. | Health | 2017-02-28 | 2017-03-26 | N |
| At least once a month, have a licensed pharmacist review each resident's medication(s) and report any irregularities to the attending doctor. | Health | 2017-02-28 | 2017-03-26 | N |
| Maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards. | Health | 2017-02-28 | 2017-03-26 | N |
| Give or get quality laboratory services/tests in a timely manner to meet the needs of residents. | Health | 2017-02-28 | 2017-03-26 | N |
| Keep accurate, complete and organized clinical records on each resident that meet professional standards. | Health | 2017-02-28 | 2017-03-26 | N |
