Deficiency Records for Addolorata Villa
Updated as of April 01, 2022
This is not the most recent data for Addolorata Villa. For the most recent information, click here.
A list of the most recent deficiencies for Addolorata Villa. 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? |
|---|---|---|---|---|
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-02-28 | 2022-03-11 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-02-28 | 2022-03-11 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2021-08-16 | 2021-10-10 | 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 | 2021-08-16 | 2021-10-10 | Y |
| Provide and implement an infection prevention and control program. | Health | 2021-08-16 | 2021-10-10 | Y |
| Conduct testing and exercise requirements. | Fire Safety | 2020-09-29 | 2020-11-13 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2020-09-29 | 2020-11-13 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2020-09-29 | 2020-11-13 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2020-09-29 | 2020-11-13 | N |
| Address patient/client population and determine types of services needed. | Fire Safety | 2020-09-29 | 2020-11-02 | N |
| Address subsistence needs for staff and patients. | Fire Safety | 2020-09-29 | 2020-11-02 | N |
| Establish policies and procedures for volunteers. | Fire Safety | 2020-09-29 | 2020-11-02 | N |
| Provide emergency officials' contact information. | Fire Safety | 2020-09-29 | 2020-11-02 | 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 | 2020-09-29 | 2020-11-02 | N |
| Properly provide smoke detection systems in areas open to corridors. | Fire Safety | 2020-09-29 | 2020-11-02 | N |
| Have a battery powered remote alarm panel in a location accessible by operating personnel. | Fire Safety | 2020-09-29 | 2020-11-02 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2020-09-29 | 2020-10-30 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2020-10-01 | 2020-10-23 | N |
| Establish staff and initial training requirements. | Fire Safety | 2020-09-29 | 2020-10-23 | N |
| Have elevators that firefighters can control in the event of a fire. | Fire Safety | 2020-09-29 | 2020-10-23 | N |
| Provide and implement an infection prevention and control program. | Health | 2020-06-11 | 2020-07-03 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2019-10-03 | 2019-11-15 | Y |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2019-03-05 | 2019-04-30 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2019-03-05 | 2019-03-15 | N |
| Have restrictions on the use of portable space heaters. | Fire Safety | 2019-03-05 | 2019-03-15 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2019-02-21 | 2019-03-08 | 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 | 2019-02-21 | 2019-03-08 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2019-02-21 | 2019-03-08 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2018-01-19 | 2018-03-01 | N |
| Ensure each resident receives an accurate assessment. | Health | 2018-01-19 | 2018-03-01 | N |
| Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | Health | 2018-01-19 | 2018-03-01 | N |
| Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | Health | 2018-01-19 | 2018-03-01 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2018-01-19 | 2018-03-01 | 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 | 2018-01-19 | 2018-03-01 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2018-01-30 | 2018-02-15 | 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 | 2018-01-30 | 2018-02-01 | N |
| Have an enclosure around a vertical opening shaft. | Fire Safety | 2018-01-30 | 2018-01-30 | N |
