Deficiency Records for Willowwood Healthcare and Rehabilitation
Updated as of March 01, 2024
A list of the most recent deficiencies for Willowwood Healthcare and Rehabilitation. 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? |
|---|---|---|---|---|
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-11-06 | 2022-12-21 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2022-11-06 | 2022-12-21 | 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 | 2022-11-06 | 2022-12-21 | N |
| Provide for the safe, appropriate administration of IV fluids for a resident when needed. | Health | 2022-11-06 | 2022-12-21 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2022-11-06 | 2022-12-21 | N |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2022-11-06 | 2022-12-21 | 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 | 2022-11-06 | 2022-12-21 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-11-06 | 2022-12-21 | N |
| Have a policy regarding use and storage of foods brought to residents by family and other visitors. | Health | 2022-11-06 | 2022-12-21 | N |
| Dispose of garbage and refuse properly. | Health | 2022-11-06 | 2022-12-21 | N |
| Implement a program that monitors antibiotic use. | Health | 2022-11-06 | 2022-12-21 | N |
| Keep all essential equipment working safely. | Health | 2022-11-06 | 2022-12-21 | 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 | 2022-11-06 | 2022-12-21 | Y |
| Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2022-11-06 | 2022-12-21 | N |
| List the names and contact information of those in the facility. | Fire Safety | 2022-11-06 | 2022-12-21 | N |
| Establish staff and initial training requirements. | Fire Safety | 2022-11-06 | 2022-12-21 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2022-11-06 | 2022-12-21 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2022-11-06 | 2022-12-21 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-11-06 | 2022-12-21 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2022-01-27 | 2022-03-13 | Y |
| 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 | 2022-01-27 | 2022-03-13 | Y |
| 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 | 2022-01-27 | 2022-03-13 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2021-06-04 | 2021-07-12 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2021-06-04 | 2021-07-12 | Y |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2021-06-02 | 2021-07-12 | 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 | 2018-09-13 | 2018-10-28 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2018-09-13 | 2018-10-28 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2018-09-13 | 2018-10-28 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2018-09-13 | 2018-10-28 | 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 | 2018-09-13 | 2018-10-28 | 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 | 2018-09-13 | 2018-10-28 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2018-09-13 | 2018-10-28 | 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 | 2018-09-13 | 2018-10-28 | 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 | 2018-09-13 | 2018-10-28 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2018-09-13 | 2018-10-28 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2018-09-13 | 2018-10-28 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2018-09-13 | 2018-10-28 | N |
