Deficiency Records for Autumn Lake Healthcare at The Willows
Updated as of March 01, 2024
A list of the most recent deficiencies for Autumn Lake Healthcare at The Willows. 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? |
|---|---|---|---|---|
| Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home. | Health | 2024-01-10 | 2024-02-24 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2024-01-10 | 2024-02-24 | 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 | 2024-01-10 | 2024-02-24 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2024-01-10 | 2024-02-24 | N |
| Assist a resident in gaining access to vision and hearing services. | Health | 2024-01-10 | 2024-02-24 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2024-01-10 | 2024-02-24 | 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 | 2024-01-10 | 2024-02-24 | N |
| Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. | Health | 2024-01-10 | 2024-02-24 | 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 | 2024-01-10 | 2024-02-24 | N |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2024-01-10 | 2024-02-24 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2024-01-10 | 2024-02-24 | N |
| Provide and implement an infection prevention and control program. | Health | 2024-01-10 | 2024-02-24 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2024-01-08 | 2024-02-05 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2024-01-08 | 2024-02-05 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2024-01-08 | 2024-02-05 | N |
| Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. | Health | 2021-09-22 | 2021-10-08 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2021-09-22 | 2021-10-08 | 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 | 2021-09-22 | 2021-10-08 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2021-07-13 | 2021-07-30 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2021-07-13 | 2021-07-30 | Y |
| Provide enough food/fluids to maintain a resident's health. | Health | 2021-07-13 | 2021-07-30 | Y |
| Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. | Health | 2021-07-13 | 2021-07-30 | Y |
| Provide and implement an infection prevention and control program. | Health | 2021-07-13 | 2021-07-30 | Y |
| Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | Health | 2021-03-03 | 2021-05-06 | Y |
| Provide and implement an infection prevention and control program. | Health | 2019-05-16 | 2019-06-01 | N |
