Deficiency Records for Pike Creek Nursing and Rehabilitation Center
Updated as of August 01, 2019
This is not the most recent data for Pike Creek Nursing and Rehabilitation Center. For the most recent information, click here.
A list of the most recent deficiencies for Pike Creek Nursing and Rehabilitation 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? |
|---|---|---|---|---|
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2019-03-06 | 2019-04-24 | N |
| 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 | 2019-03-06 | 2019-04-24 | 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 | 2019-03-06 | 2019-04-24 | N |
| Ensure each resident receives an accurate assessment. | Health | 2019-03-06 | 2019-04-24 | 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 | 2019-03-06 | 2019-04-24 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2019-03-06 | 2019-04-24 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2019-03-06 | 2019-04-24 | N |
| Provide activities to meet all resident's needs. | Health | 2019-03-06 | 2019-04-24 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2019-03-06 | 2019-04-24 | N |
| Provide safe, appropriate pain management for a resident who requires such services. | Health | 2019-03-06 | 2019-04-24 | 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 | 2019-03-06 | 2019-04-24 | 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 ne | Health | 2019-03-06 | 2019-04-24 | N |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2019-03-06 | 2019-04-24 | N |
| Ensure meals and snacks are served at times in accordance with resident?s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of schedul | Health | 2019-03-06 | 2019-04-24 | N |
| Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | Health | 2019-03-06 | 2019-04-24 | N |
| Have stairways and smokeproof enclosures used as exits that meet safety requirements. | Fire Safety | 2019-03-08 | 2019-04-02 | N |
| Have properly located and lighted "Exit" signs. | Fire Safety | 2019-03-08 | 2019-04-02 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2019-03-08 | 2019-04-02 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2019-03-08 | 2019-04-02 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2019-03-08 | 2019-04-02 | N |
| Meet other general requirements that are deficient. | Fire Safety | 2019-03-08 | 2019-04-02 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2019-03-06 | 2019-03-31 | Y |
| Provide and implement an infection prevention and control program. | Health | 2019-01-10 | 2019-02-07 | Y |
| Provide and implement an infection prevention and control program. | Health | 2018-03-01 | 2018-06-07 | N |
| Provide family notifications of emergency plan. | Fire Safety | 2018-03-01 | 2018-04-25 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2018-03-01 | 2018-04-25 | Y |
| Ensure each resident receives an accurate assessment. | Health | 2018-03-01 | 2018-04-25 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2018-03-01 | 2018-04-25 | N |
| Allow residents to easily view the nursing home's survey results and communicate with advocate agencies. | Health | 2018-03-01 | 2018-04-25 | 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 | 2018-03-01 | 2018-04-25 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2018-03-01 | 2018-04-25 | N |
| Notify the resident or the resident?s representative in writing how long the nursing home will hold the resident?s bed in cases of transfer to a hospital or therapeutic leave. | Health | 2018-03-01 | 2018-04-25 | N |
| Provide activities to meet all resident's needs. | Health | 2018-03-01 | 2018-04-25 | 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 | 2018-03-01 | 2018-04-25 | 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 | 2018-03-01 | 2018-04-25 | N |
| Ensure that residents are free from significant medication errors. | Health | 2018-03-01 | 2018-04-25 | N |
| Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. | Health | 2018-03-01 | 2018-04-25 | N |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2018-03-01 | 2018-04-25 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2018-03-01 | 2018-04-25 | N |
| Dispose of garbage and refuse properly. | Health | 2018-03-01 | 2018-04-25 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2018-03-01 | 2018-04-25 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2018-03-01 | 2018-04-25 | Y |
| Use approved construction type or materials. | Fire Safety | 2018-02-26 | 2018-04-04 | N |
| Have properly located and lighted "Exit" signs. | Fire Safety | 2018-02-26 | 2018-04-04 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2018-02-26 | 2018-04-04 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2018-02-26 | 2018-04-04 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2018-02-26 | 2018-04-04 | N |
| Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. | Health | 2017-06-14 | 2017-10-20 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2017-06-14 | 2017-07-20 | Y |
| 1) Hire only people with no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents. | Health | 2017-06-14 | 2017-07-20 | Y |
| Provide necessary care and services to maintain or improve the highest well being of each resident . | Health | 2017-06-14 | 2017-07-20 | Y |
| Have a program that investigates, controls and keeps infection from spreading. | Health | 2017-06-14 | 2017-07-20 | Y |
| Keep accurate, complete and organized clinical records on each resident that meet professional standards. | Health | 2017-06-14 | 2017-07-20 | Y |
| Provide medically-related social services to help each resident achieve the highest possible quality of life. | Health | 2016-12-21 | 2017-01-13 | N |
| Provide housekeeping and maintenance services. | Health | 2016-12-21 | 2017-01-13 | N |
| Conduct initial and periodic assessments of each resident's functional capacity. | Health | 2016-12-21 | 2017-01-13 | N |
| Review or revise the resident's care plan after any major change in physical or mental health. | Health | 2016-12-21 | 2017-01-13 | N |
| Ensure each resident receives an accurate assessment by a qualified health professional. | Health | 2016-12-21 | 2017-01-13 | N |
| Allow residents the right to participate in the planning or revision of care and treatment. | Health | 2016-12-21 | 2017-01-13 | N |
| Assist those residents who need help with eating/drinking, grooming and personal and oral hygiene. | Health | 2016-12-21 | 2017-01-13 | N |
| Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. | Health | 2016-12-21 | 2017-01-13 | N |
| Store, cook, and serve food in a safe and clean way. | Health | 2016-12-21 | 2017-01-13 | N |
| Provide or obtain dental services for each resident. | Health | 2016-12-21 | 2017-01-13 | N |
| Make sure that a working call system is available in each resident's room or bathroom and bathing area. | Health | 2016-12-21 | 2017-01-13 | N |
| Keep accurate, complete and organized clinical records on each resident that meet professional standards. | Health | 2016-12-21 | 2017-01-13 | N |
