A list of the most recent deficiencies for Bridgeway Senior Living. 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 | 2024-02-01 | 2024-02-15 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2024-02-01 | 2024-02-12 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2024-02-01 | 2024-02-08 | 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 | 2024-02-01 | 2024-02-08 | N |
| Have exits that are accessible at all times. | Fire Safety | 2024-02-01 | 2024-02-08 | 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 | 2024-02-01 | 2024-02-08 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2024-02-01 | 2024-02-08 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2024-02-01 | 2024-02-08 | N |
| Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke. | Fire Safety | 2024-02-01 | 2024-02-08 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2024-02-01 | 2024-02-08 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2024-02-01 | 2024-02-08 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2024-02-01 | 2024-02-08 | N |
| Ensure that gas fire places are out of the reach of patients and can be shut off if unit is working improperly. | Fire Safety | 2024-02-01 | 2024-02-08 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2024-02-01 | 2024-02-08 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2024-02-01 | 2024-02-08 | N |
| Have restrictions on the use of portable space heaters. | Fire Safety | 2024-02-01 | 2024-02-08 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2024-02-01 | 2024-02-08 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2024-02-01 | 2024-02-08 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2024-02-01 | 2024-02-08 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2024-01-25 | 2024-02-06 | N |
| Post a list of names, addresses, and telephone numbers of all pertinent State agencies and advocacy groups and a statement that the resident may file a complaint with the State Survey Agency. | Health | 2024-01-25 | 2024-02-06 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2024-01-25 | 2024-02-06 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2024-01-25 | 2024-02-06 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2024-01-25 | 2024-02-06 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2024-01-25 | 2024-02-06 | 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 | 2024-01-25 | 2024-02-06 | 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 | 2024-01-25 | 2024-02-06 | N |
| Provide safe, appropriate pain management for a resident who requires such services. | Health | 2024-01-25 | 2024-02-06 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2024-01-25 | 2024-02-06 | 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 | 2024-01-25 | 2024-02-06 | 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 | 2024-01-25 | 2024-02-06 | N |
| Provide and implement an infection prevention and control program. | Health | 2024-01-25 | 2024-02-06 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2023-05-04 | 2023-05-18 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-05-04 | 2023-05-18 | Y |
| Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. | Health | 2023-05-04 | 2023-05-18 | Y |
| Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. | Health | 2023-05-04 | 2023-05-18 | Y |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2023-05-04 | 2023-05-18 | Y |
| Conduct testing and exercise requirements. | Fire Safety | 2023-02-22 | 2023-03-22 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-02-22 | 2023-03-20 | N |
| Address patient/client population and determine types of services needed. | Fire Safety | 2023-02-22 | 2023-03-17 | N |
| Address subsistence needs for staff and patients. | Fire Safety | 2023-02-22 | 2023-03-17 | N |
| Establish policies and procedures for sheltering. | Fire Safety | 2023-02-22 | 2023-03-17 | N |
| Create arrangements with other facilities to receive patients. | Fire Safety | 2023-02-22 | 2023-03-17 | N |
| List the names and contact information of those in the facility. | Fire Safety | 2023-02-22 | 2023-03-17 | N |
| Establish staff and initial training requirements. | Fire Safety | 2023-02-22 | 2023-03-17 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-02-22 | 2023-03-17 | 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 | 2023-02-22 | 2023-03-10 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2023-02-22 | 2023-03-10 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2023-02-22 | 2023-03-10 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2023-02-22 | 2023-03-10 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2023-02-22 | 2023-03-10 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2023-02-22 | 2023-03-10 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2023-02-22 | 2023-03-10 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2023-02-22 | 2023-03-10 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2023-02-22 | 2023-03-10 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2023-02-22 | 2023-03-10 | N |
| Ensure precautions for handling oxygen cylinders and equipment are correctly followed. | Fire Safety | 2023-02-22 | 2023-03-10 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2023-02-22 | 2023-03-09 | N |
| Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2023-02-22 | 2023-03-03 | N |
| Establish policies and procedures for medical documentation. | Fire Safety | 2023-02-22 | 2023-03-03 | N |
| Provide primary/alternate means for communication. | Fire Safety | 2023-02-22 | 2023-03-03 | N |
| Provide family notifications of emergency plan. | Fire Safety | 2023-02-22 | 2023-03-03 | N |
| Implement emergency and standby power systems. | Fire Safety | 2023-02-22 | 2023-03-03 | N |
| Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | Health | 2023-02-17 | 2023-02-24 | 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 | 2023-02-17 | 2023-02-24 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-02-17 | 2023-02-24 | N |
| Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. | Health | 2023-02-17 | 2023-02-24 | N |
| Provide for the safe, appropriate administration of IV fluids for a resident when needed. | Health | 2023-02-17 | 2023-02-24 | N |
| Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. | Health | 2023-02-17 | 2023-02-24 | N |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2023-02-17 | 2023-02-24 | N |
| Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. | Health | 2023-02-17 | 2023-02-24 | N |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2022-11-22 | 2022-11-23 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-11-22 | 2022-11-23 | Y |
| Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | Health | 2022-11-22 | 2022-11-23 | Y |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2022-10-28 | 2022-11-03 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-09-19 | 2022-09-22 | Y |
| Protect each resident from the wrongful use of the resident's belongings or money. | Health | 2022-07-07 | 2022-07-15 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-07-07 | 2022-07-15 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-03-31 | 2022-04-13 | Y |
| Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | Health | 2022-03-31 | 2022-04-13 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-02-23 | 2022-02-24 | Y |
| Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. | Health | 2022-01-25 | 2022-02-03 | Y |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2021-10-06 | 2021-11-19 | N |
| Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2021-10-06 | 2021-10-18 | N |
| Conduct risk assessment and an All-Hazards approach. | Fire Safety | 2021-10-06 | 2021-10-18 | N |
| Address patient/client population and determine types of services needed. | Fire Safety | 2021-10-06 | 2021-10-18 | N |
| Address subsistence needs for staff and patients. | Fire Safety | 2021-10-06 | 2021-10-18 | N |
| Establish policies and procedures for volunteers. | Fire Safety | 2021-10-06 | 2021-10-18 | N |
| Establish emergency prep training and testing. | Fire Safety | 2021-10-06 | 2021-10-18 | N |
| Establish staff and initial training requirements. | Fire Safety | 2021-10-06 | 2021-10-18 | 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 | 2021-10-06 | 2021-10-18 | N |
| Have exits that are accessible at all times. | Fire Safety | 2021-10-06 | 2021-10-18 | 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 | 2021-10-06 | 2021-10-18 | N |
| Have properly installed hallway dispensers for alcohol-based hand rub. | Fire Safety | 2021-10-06 | 2021-10-18 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2021-10-06 | 2021-10-18 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2021-10-06 | 2021-10-18 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2021-10-06 | 2021-10-18 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2021-10-06 | 2021-10-18 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2021-09-24 | 2021-09-29 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-09-24 | 2021-09-29 | N |
| Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. | Health | 2021-09-24 | 2021-09-29 | N |
| Ensure that residents are free from significant medication errors. | Health | 2021-09-24 | 2021-09-29 | 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 | 2021-09-24 | 2021-09-29 | N |
| Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. | Health | 2021-09-24 | 2021-09-29 | N |
| Provide and implement an infection prevention and control program. | Health | 2021-09-24 | 2021-09-29 | 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 | 2021-09-24 | 2021-09-29 | Y |
| Provide enough food/fluids to maintain a resident's health. | Health | 2021-03-25 | 2021-03-29 | Y |
