Deficiency Records for Highlight Healthcare of Aurora
Updated as of October 01, 2021
This is not the most recent data for Highlight Healthcare of Aurora. For the most recent information, click here.
A list of the most recent deficiencies for Highlight Healthcare of Aurora. 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 a complete alarm system manually initiated and initiated by fire sprinkler system connection. | Fire Safety | 2021-01-27 | 2021-02-12 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2021-01-27 | 2021-02-12 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2021-01-27 | 2021-02-12 | N |
| Use approved construction type or materials. | Fire Safety | 2021-01-27 | 2021-02-09 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2021-01-27 | 2021-02-09 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2021-01-27 | 2021-02-03 | N |
| Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2021-01-27 | 2021-02-01 | N |
| Establish procedures for tracking staff and patients during an emergency. | Fire Safety | 2021-01-27 | 2021-01-29 | N |
| Establish policies and procedures including evacuation. | Fire Safety | 2021-01-27 | 2021-01-29 | N |
| Implement emergency and standby power systems. | Fire Safety | 2021-01-27 | 2021-01-29 | 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 | 2021-01-27 | 2021-01-29 | N |
| Construct fire resistant interior walls. | Fire Safety | 2021-01-27 | 2021-01-29 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2021-01-27 | 2021-01-29 | N |
| Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke. | Fire Safety | 2021-01-27 | 2021-01-29 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2021-01-27 | 2021-01-29 | N |
| List the names and contact information of those in the facility. | Fire Safety | 2021-01-27 | 2021-01-28 | N |
| Have an enclosure around a vertical opening shaft. | Fire Safety | 2021-01-27 | 2021-01-28 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2021-01-27 | 2021-01-28 | N |
| Install a fire alarm system that can be heard throughout the facility. | Fire Safety | 2021-01-27 | 2021-01-28 | N |
| Follow proper procedures when the fire alarm was out of service for more than 4 hours. | Fire Safety | 2021-01-27 | 2021-01-28 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2021-01-27 | 2021-01-28 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2021-01-27 | 2021-01-28 | N |
| Provide a written emergency evacuation plan. | Fire Safety | 2021-01-27 | 2021-01-28 | N |
| Have restrictions on the use of portable space heaters. | Fire Safety | 2021-01-27 | 2021-01-28 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2021-01-27 | 2021-01-28 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2021-01-27 | 2021-01-28 | N |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2020-11-05 | 2020-11-25 | Y |
| Respond appropriately to all alleged violations. | Health | 2020-11-05 | 2020-11-25 | Y |
| Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. | Fire Safety | 2019-06-21 | 2019-11-22 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2019-06-21 | 2019-11-22 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2019-07-18 | 2019-07-26 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2019-07-18 | 2019-07-26 | Y |
| Use approved construction type or materials. | Fire Safety | 2019-06-21 | 2019-07-17 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2019-06-21 | 2019-07-17 | N |
| Properly provide smoke detection systems in areas open to corridors. | Fire Safety | 2019-06-21 | 2019-07-17 | N |
| Properly install and monitor supervisory attachments on automatic sprinkler systems. | Fire Safety | 2019-06-21 | 2019-07-17 | N |
| Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2019-06-21 | 2019-07-17 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2019-06-21 | 2019-07-17 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2019-06-21 | 2019-07-17 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2019-06-21 | 2019-07-17 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2019-06-21 | 2019-07-17 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2019-06-21 | 2019-07-17 | N |
| Have restrictions on the use of portable space heaters. | Fire Safety | 2019-06-21 | 2019-07-17 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2019-06-21 | 2019-07-17 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2019-06-21 | 2019-07-17 | N |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2019-06-13 | 2019-06-24 | 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 | 2019-06-13 | 2019-06-24 | 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 | 2019-06-13 | 2019-06-24 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2018-12-17 | 2019-01-10 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2018-12-17 | 2019-01-07 | Y |
| Provide enough food/fluids to maintain a resident's health. | Health | 2018-12-17 | 2019-01-07 | Y |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2018-05-01 | 2018-06-27 | N |
| Use approved construction type or materials. | Fire Safety | 2018-05-01 | 2018-06-04 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2018-05-01 | 2018-06-04 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2018-05-01 | 2018-06-01 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2018-05-01 | 2018-05-31 | 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 | 2018-05-01 | 2018-05-24 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2018-05-01 | 2018-05-24 | N |
| Have properly located and lighted "Exit" signs. | Fire Safety | 2018-05-01 | 2018-05-18 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2018-05-01 | 2018-05-18 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2018-05-01 | 2018-05-18 | N |
| Have restrictions on the use of portable space heaters. | Fire Safety | 2018-05-01 | 2018-05-18 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2018-05-01 | 2018-05-18 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2018-05-01 | 2018-05-18 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2018-05-01 | 2018-05-18 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2018-04-25 | 2018-05-08 | N |
| Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. | Health | 2018-04-25 | 2018-05-08 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2018-04-25 | 2018-05-08 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2018-04-25 | 2018-05-08 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2018-04-25 | 2018-05-08 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2018-04-25 | 2018-05-08 | 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 | 2018-04-25 | 2018-05-08 | N |
| Provide special eating equipment and utensils for residents who need them and appropriate assistance. | Health | 2018-04-25 | 2018-05-08 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2018-04-25 | 2018-05-08 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2018-04-25 | 2018-05-08 | N |
