A list of the most recent deficiencies for Dekalb County Rehab and Nursing. 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? |
---|---|---|---|---|
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2024-01-24 | 2024-02-05 | Y |
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2023-09-13 | 2023-10-04 | Y |
Provide and implement an infection prevention and control program. | Health | 2023-09-13 | 2023-10-04 | Y |
Protect each resident from the wrongful use of the resident's belongings or money. | Health | 2023-06-22 | 2023-07-11 | Y |
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-06-22 | 2023-07-11 | Y |
Provide primary/alternate means for communication. | Fire Safety | 2023-03-10 | 2023-03-30 | 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 | 2023-03-10 | 2023-03-30 | N |
Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke. | Fire Safety | 2023-03-10 | 2023-03-30 | N |
Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2023-02-23 | 2023-03-09 | N |
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-02-23 | 2023-03-09 | N |
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2023-02-23 | 2023-03-09 | N |
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-02-23 | 2023-03-09 | N |
Provide and implement an infection prevention and control program. | Health | 2023-02-23 | 2023-03-09 | N |
Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-08-17 | 2022-08-26 | Y |
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2022-08-17 | 2022-08-26 | 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 | 2022-08-17 | 2022-08-24 | Y |
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-07-14 | 2022-07-26 | Y |
Ensure gas and vacuum systems are inspected and tested as part of a maintenance program. | Fire Safety | 2022-01-21 | 2022-03-11 | N |
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2022-01-21 | 2022-02-28 | 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 | 2022-01-21 | 2022-02-21 | N |
Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2022-01-21 | 2022-02-21 | 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 | 2022-01-21 | 2022-02-21 | N |
Have properly located and lighted "Exit" signs. | Fire Safety | 2022-01-21 | 2022-02-16 | N |
Provide properly protected cooking facilities. | Fire Safety | 2022-01-21 | 2022-02-14 | N |
Install a fire alarm system that can be heard throughout the facility. | Fire Safety | 2022-01-21 | 2022-02-14 | N |
Ensure that any exit in an area undergoing construction, repair, or improvements shall be inspected daily to ensure its ability to be used instantly in case of emergency. | Fire Safety | 2022-01-21 | 2022-02-14 | N |
Address patient/client population and determine types of services needed. | Fire Safety | 2022-01-21 | 2022-02-13 | N |
Establish policies and procedures for volunteers. | Fire Safety | 2022-01-21 | 2022-02-13 | N |
Provide family notifications of emergency plan. | Fire Safety | 2022-01-21 | 2022-02-13 | N |
Install a two-hour-resistant firewall separation. | Fire Safety | 2022-01-21 | 2022-02-09 | N |
Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-01-21 | 2022-02-07 | N |
Reasonably accommodate the needs and preferences of each resident. | Health | 2022-01-13 | 2022-01-25 | 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 | 2022-01-13 | 2022-01-25 | N |
Provide enough food/fluids to maintain a resident's health. | Health | 2022-01-13 | 2022-01-25 | N |
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-01-13 | 2022-01-25 | N |
Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2022-01-13 | 2022-01-25 | Y |
Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2022-01-21 | 2022-01-25 | 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 | 2022-01-21 | 2022-01-24 | N |
Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2020-11-05 | 2021-04-13 | N |
Address subsistence needs for staff and patients. | Fire Safety | 2020-11-05 | 2021-04-13 | N |
Establish policies and procedures including evacuation. | Fire Safety | 2020-11-05 | 2021-04-13 | N |
Establish methods for sharing information. | Fire Safety | 2020-11-05 | 2021-04-09 | N |
Establish staff and initial training requirements. | Fire Safety | 2020-11-05 | 2021-04-09 | N |
Provide a means of sharing information on occupancy/needs. | Fire Safety | 2020-11-05 | 2021-04-08 | N |
Provide family notifications of emergency plan. | Fire Safety | 2020-11-05 | 2021-04-08 | N |
Conduct testing and exercise requirements. | Fire Safety | 2020-11-05 | 2021-04-08 | N |
Address patient/client population and determine types of services needed. | Fire Safety | 2020-11-05 | 2021-04-06 | N |
Develop Emergency Preparedness policies and procedures. | Fire Safety | 2020-11-05 | 2021-04-05 | N |
Develop a communication plan. | Fire Safety | 2020-11-05 | 2021-04-05 | N |
Provide emergency officials' contact information. | Fire Safety | 2020-11-05 | 2021-04-05 | N |
List the names and contact information of those in the facility. | Fire Safety | 2020-11-05 | 2021-04-03 | N |
Provide primary/alternate means for communication. | Fire Safety | 2020-11-05 | 2021-04-02 | N |
Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2020-11-05 | 2021-03-24 | N |
Implement emergency and standby power systems. | Fire Safety | 2020-11-05 | 2021-03-16 | N |
Establish procedures for tracking staff and patients during an emergency. | Fire Safety | 2020-11-05 | 2021-03-13 | N |
Establish policies and procedures for sheltering. | Fire Safety | 2020-11-05 | 2021-03-13 | N |
Establish policies and procedures for volunteers. | Fire Safety | 2020-11-05 | 2021-03-13 | N |
Create arrangements with other facilities to receive patients. | Fire Safety | 2020-11-05 | 2021-03-13 | N |
Conduct risk assessment and an All-Hazards approach. | Fire Safety | 2020-11-05 | 2020-12-20 | N |
Provide a written emergency evacuation plan. | Fire Safety | 2020-11-05 | 2020-12-09 | N |
Protect each resident from the wrongful use of the resident's belongings or money. | Health | 2020-10-28 | 2020-12-02 | N |
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2020-10-28 | 2020-12-02 | N |
Keep all essential equipment working safely. | Health | 2020-10-28 | 2020-11-25 | N |
Follow proper procedures when the fire alarm was out of service for more than 4 hours. | Fire Safety | 2020-11-05 | 2020-11-25 | N |
Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2020-11-05 | 2020-11-25 | N |
To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2020-11-05 | 2020-11-25 | 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 | 2020-10-28 | 2020-11-18 | 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 | 2020-10-28 | 2020-11-18 | 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 | 2020-10-28 | 2020-11-18 | 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 | 2020-10-28 | 2020-11-18 | N |
Provide and implement an infection prevention and control program. | Health | 2020-10-28 | 2020-11-18 | N |
Provide properly protected cooking facilities. | Fire Safety | 2020-11-05 | 2020-11-17 | N |
Install corridor and hallway doors that block smoke. | Fire Safety | 2020-11-05 | 2020-11-16 | 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 | 2020-11-05 | 2020-11-11 | N |
Install a two-hour-resistant firewall separation. | Fire Safety | 2020-11-05 | 2020-11-06 | N |