A list of the most recent deficiencies for Wrightsville Manor Health and Rehab. 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? |
|---|---|---|---|---|
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-10-08 | 2023-12-26 | N |
| Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. | Health | 2023-10-08 | 2023-12-26 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-10-08 | 2023-11-15 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-10-08 | 2023-11-15 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2023-10-07 | 2023-10-27 | 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 | 2022-05-15 | 2022-06-28 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-05-15 | 2022-06-28 | 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 | 2022-05-15 | 2022-06-28 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-05-15 | 2022-06-28 | N |
| Respond appropriately to all alleged violations. | Health | 2021-04-07 | 2021-05-01 | Y |
| Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | Health | 2019-03-07 | 2019-04-21 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2019-03-07 | 2019-04-21 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2019-03-07 | 2019-04-21 | N |
| Provide and implement an infection prevention and control program. | Health | 2019-03-07 | 2019-04-21 | N |
| Conduct risk assessment and an All-Hazards approach. | Fire Safety | 2019-03-07 | 2019-04-21 | N |
| Provide emergency officials' contact information. | Fire Safety | 2019-03-07 | 2019-04-21 | N |
| Establish staff and initial training requirements. | Fire Safety | 2019-03-07 | 2019-04-21 | 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 | 2019-03-07 | 2019-04-21 | N |
| Have an enclosure around a vertical opening shaft. | Fire Safety | 2019-03-07 | 2019-04-21 | 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 | 2019-03-07 | 2019-04-21 | N |
| Install a fire alarm system that can be heard throughout the facility. | Fire Safety | 2019-03-07 | 2019-04-21 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2019-03-07 | 2019-04-21 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2019-03-07 | 2019-04-21 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2019-03-07 | 2019-04-21 | N |
| Meet requirements for operating features, such as evacuation plans, fire drills, smoking regulations, draperies, decorations and the inspection, testing and maintenance of fire doors. | Fire Safety | 2019-03-07 | 2019-04-21 | N |
| Have restrictions on the use of highly flammable decorations. | Fire Safety | 2019-03-07 | 2019-04-21 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2019-03-07 | 2019-04-21 | N |
| Ensure precautions for handling oxygen cylinders and equipment are correctly followed. | Fire Safety | 2019-03-07 | 2019-04-21 | N |
