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Deficiency Records for The Pavilion at Villa Pueblo

View the most recent health deficiencies and inspection results for The Pavilion at Villa Pueblo. Stay informed about quality of care issues.

View the most recent health deficiencies and inspection results for The Pavilion at Villa Pueblo. Stay informed about quality of care issues.

Deficiency Type of Deficiency Deficiency Date Date Corrected Resulted from a Complaint?
Use approved construction type or materials. Fire Safety 2025-12-04 2026-02-03 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 2025-12-04 2026-02-03 N
Keep aisles, corridors, and exits free of obstruction in case of emergency. Fire Safety 2025-12-04 2025-12-26 N
Install smoke barrier doors that can resist smoke for at least 20 minutes. Fire Safety 2025-12-04 2025-12-26 N
Ensure smoke barriers are constructed to a 1 hour fire resistance rating. Fire Safety 2025-12-04 2025-12-26 N
Install corridor and hallway doors that block smoke. Fire Safety 2025-12-04 2025-12-26 N
Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke. Fire Safety 2025-12-04 2025-12-26 N
Inspect, test, and maintain automatic sprinkler systems. Fire Safety 2025-12-04 2025-12-26 N
Have approved installation, maintenance and testing program for fire alarm systems. Fire Safety 2025-12-04 2025-12-26 N
Install a fire alarm system that can be heard throughout the facility. Fire Safety 2025-12-04 2025-12-26 N
Have properly installed hallway dispensers for alcohol-based hand rub. Fire Safety 2025-12-04 2025-12-26 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 2025-12-04 2025-12-26 N
Have properly located and lighted "Exit" signs. Fire Safety 2025-12-04 2025-12-26 N
Install emergency lighting that can last at least 1 1/2 hours. Fire Safety 2025-12-04 2025-12-26 N
Implement a program that monitors antibiotic use. Health 2025-12-04 2025-12-05 N
Provide and implement an infection prevention and control program. Health 2025-12-04 2025-12-05 N
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2025-12-04 2025-12-05 N
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Health 2025-12-04 2025-12-05 N
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2025-12-04 2025-12-05 N
Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. Health 2025-12-04 2025-12-05 N
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2025-05-15 2025-06-11 Y
Ensure services provided by the nursing facility meet professional standards of quality. Health 2025-05-15 2025-06-11 Y
Provide care and assistance to perform activities of daily living for any resident who is unable. Health 2025-05-15 2025-06-11 Y
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Health 2025-05-15 2025-06-11 Y
Inspect, test, and maintain automatic sprinkler systems. Fire Safety 2023-12-14 2024-04-15 N
Have simulated fire drills held at unexpected times. Fire Safety 2023-12-14 2024-02-10 N
Install corridor and hallway doors that block smoke. Fire Safety 2023-12-14 2024-02-10 N
Have approved installation, maintenance and testing program for fire alarm systems. Fire Safety 2023-12-14 2024-02-10 N
Have properly located and lighted "Exit" signs. Fire Safety 2023-12-14 2024-02-10 N
Provide and implement an infection prevention and control program. Health 2023-12-14 2024-01-11 Y
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2023-12-14 2024-01-11 N
Ensure medication error rates are not 5 percent or greater. Health 2023-12-14 2024-01-11 N
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. Health 2023-12-14 2024-01-11 N
Provide safe and appropriate respiratory care for a resident when needed. Health 2023-12-14 2024-01-11 N
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2023-12-14 2024-01-11 N
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2023-12-14 2024-01-11 N
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Health 2023-08-09 2023-09-06 Y
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2023-08-09 2023-09-06 Y
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. Health 2023-08-09 2023-09-06 Y
Have simulated fire drills held at unexpected times. Fire Safety 2022-09-01 2022-12-20 N
Have generator or other power source capable of supplying service within 10 seconds. Fire Safety 2022-09-01 2022-12-20 N
Have approved installation, maintenance and testing program for fire alarm systems. Fire Safety 2022-09-01 2022-12-19 N
Inspect, test, and maintain automatic sprinkler systems. Fire Safety 2022-09-01 2022-12-15 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 2022-09-01 2022-10-01 N
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2022-09-01 2022-10-01 N
Provide care and assistance to perform activities of daily living for any resident who is unable. Health 2022-09-01 2022-10-01 N
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2022-09-01 2022-10-01 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 2022-09-01 2022-10-01 N
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2022-09-01 2022-10-01 N
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Health 2022-09-01 2022-10-01 N
Ensure medication error rates are not 5 percent or greater. Health 2022-09-01 2022-10-01 N
Ensure that residents are free from significant medication errors. Health 2022-09-01 2022-10-01 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 2022-09-01 2022-10-01 N
Provide and implement an infection prevention and control program. Health 2022-09-01 2022-10-01 N

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