A list of the most recent deficiencies for Michaelsen 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? |
|---|---|---|---|---|
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2023-09-26 | 2023-10-30 | N |
| Have elevators that firefighters can control in the event of a fire. | Fire Safety | 2023-09-26 | 2023-10-30 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2023-09-26 | 2023-10-23 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2023-09-28 | 2023-10-13 | N |
| 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 | 2023-09-28 | 2023-10-13 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-09-28 | 2023-10-13 | 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 | 2023-09-28 | 2023-10-13 | 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 | 2023-09-28 | 2023-10-13 | N |
| Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. | Health | 2023-09-28 | 2023-10-13 | N |
| Establish roles under a Waiver declared by secretary. | Fire Safety | 2023-09-26 | 2023-10-13 | N |
| Conduct testing and exercise requirements. | Fire Safety | 2023-09-26 | 2023-10-13 | N |
| Install a two-hour-resistant firewall separation. | Fire Safety | 2023-09-26 | 2023-10-13 | N |
| Have exits that are accessible at all times. | Fire Safety | 2023-09-26 | 2023-10-13 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-09-26 | 2023-10-13 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-02-16 | 2023-03-03 | Y |
| Establish staff and initial training requirements. | Fire Safety | 2023-01-04 | 2023-01-22 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2023-01-04 | 2023-01-22 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2023-01-04 | 2023-01-22 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-01-04 | 2023-01-22 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-12-09 | 2022-12-29 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-12-09 | 2022-12-29 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2021-12-16 | 2022-01-09 | N |
| Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | Health | 2021-12-16 | 2022-01-09 | N |
| Ensure each resident receives an accurate assessment. | Health | 2021-12-16 | 2022-01-09 | N |
| Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. | Health | 2021-12-16 | 2022-01-09 | N |
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2021-12-16 | 2022-01-09 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2021-12-16 | 2022-01-09 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2021-12-16 | 2022-01-09 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2021-12-16 | 2022-01-09 | N |
| Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. | Health | 2021-12-16 | 2022-01-09 | N |
| Ensure each resident must receive and the facility must provide necessary behavioral health care and services. | Health | 2021-12-16 | 2022-01-09 | N |
| Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents. | Health | 2021-12-16 | 2022-01-09 | N |
| Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. | Health | 2021-12-16 | 2022-01-09 | 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 | 2021-12-16 | 2022-01-09 | N |
| Provide and implement an infection prevention and control program. | Health | 2021-12-16 | 2022-01-09 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2021-12-16 | 2022-01-09 | N |
| Establish policies and procedures for sheltering. | Fire Safety | 2021-12-07 | 2022-01-07 | N |
| Establish staff and initial training requirements. | Fire Safety | 2021-12-07 | 2022-01-07 | N |
| Have properly installed hallway dispensers for alcohol-based hand rub. | Fire Safety | 2021-12-07 | 2021-12-29 | 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 | 2021-12-07 | 2021-12-09 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2021-12-07 | 2021-12-09 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2021-12-07 | 2021-12-08 | N |
