Deficiency Records for Pinnacle Rehabilitation and Health Center
Updated as of March 01, 2024
A list of the most recent deficiencies for Pinnacle Rehabilitation and Health 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? |
|---|---|---|---|---|
| Provide and implement an infection prevention and control program. | Health | 2021-03-17 | 2021-03-30 | Y |
| Ensure that residents are fully informed and understand their health status, care and treatments. | Health | 2020-01-17 | 2020-02-13 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2020-01-17 | 2020-02-13 | 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 | 2020-01-17 | 2020-02-13 | N |
| Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | Health | 2020-01-17 | 2020-02-13 | N |
| Provide activities to meet all resident's needs. | Health | 2020-01-17 | 2020-02-13 | N |
| Obtain a doctor's order to admit a resident and ensure the resident is under a doctor's care. | Health | 2020-01-17 | 2020-02-13 | N |
| Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | Health | 2020-01-17 | 2020-02-13 | N |
| Provide and implement an infection prevention and control program. | Health | 2020-01-17 | 2020-02-13 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2020-01-17 | 2020-02-13 | N |
| Have exits that are accessible at all times. | Fire Safety | 2018-12-12 | 2019-01-02 | N |
| Keep residents' personal and medical records private and confidential. | Health | 2018-11-20 | 2018-12-21 | N |
| Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. | Health | 2018-11-20 | 2018-12-21 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2018-11-20 | 2018-12-21 | N |
| Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. | Health | 2018-11-20 | 2018-12-21 | N |
| Encode each resident?s assessment data and transmit these data to the State within 7 days of assessment. | Health | 2018-11-20 | 2018-12-21 | N |
| Ensure each resident receives an accurate assessment. | Health | 2018-11-20 | 2018-12-21 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2018-11-20 | 2018-12-21 | 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 | 2018-11-20 | 2018-12-21 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2018-11-20 | 2018-12-21 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2018-11-20 | 2018-12-21 | N |
| Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | Health | 2018-11-20 | 2018-12-21 | N |
| Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. | Health | 2018-11-20 | 2018-12-21 | 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 | 2018-11-20 | 2018-12-21 | N |
| Provide or obtain dental services for each resident. | Health | 2018-11-20 | 2018-12-21 | N |
| Provide and implement an infection prevention and control program. | Health | 2018-11-20 | 2018-12-21 | N |
| Implement a program that monitors antibiotic use. | Health | 2018-11-20 | 2018-12-21 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2018-11-20 | 2018-12-21 | N |
| Keep all essential equipment working safely. | Health | 2018-11-20 | 2018-12-21 | N |
| Provide residents with private access to a telephone. | Health | 2017-10-17 | 2017-11-09 | N |
| Provide care for residents in a way that maintains or improves their dignity and respect in full recognition of their individuality. | Health | 2017-10-17 | 2017-11-09 | N |
| Ensure residents have the right to have a choice over activities, their schedules, and health care according to their interests, assessments, and plans of care. | Health | 2017-10-17 | 2017-11-09 | N |
| Listen to the resident groups and act on their complaints and suggestions that affect resident care and life. | Health | 2017-10-17 | 2017-11-09 | N |
| Maintain comfortable and safe temperature levels. | Health | 2017-10-17 | 2017-11-09 | N |
| Maintain comfortable sound levels. | Health | 2017-10-17 | 2017-11-09 | N |
| Assure that each resident?s assessment is updated at least once every 3 months. | Health | 2017-10-17 | 2017-11-09 | N |
| Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2017-10-17 | 2017-11-09 | N |
| Allow residents the right to participate in the planning or revision of care and treatment. | Health | 2017-10-17 | 2017-11-09 | 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 | 2017-10-17 | 2017-11-09 | N |
| Post nurse staffing information/data on a daily basis. | Health | 2017-10-17 | 2017-11-09 | N |
| Hire sufficient dietary support personnel. | Health | 2017-10-17 | 2017-11-09 | N |
| Store, cook, and serve food in a safe and clean way. | Health | 2017-10-17 | 2017-11-09 | N |
| Give or get specialized rehabilitative services per the patient's assessment or plan of care. | Health | 2017-10-17 | 2017-11-09 | N |
| Have a program that investigates, controls and keeps infection from spreading. | Health | 2017-10-17 | 2017-11-09 | N |
| Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. | Health | 2017-10-17 | 2017-11-09 | N |
