A list of the most recent deficiencies for Polo Rehabilitation and Hcc. 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? |
|---|---|---|---|---|
| Provide properly protected cooking facilities. | Fire Safety | 2023-05-08 | 2023-06-09 | N |
| Conduct testing and exercise requirements. | Fire Safety | 2023-05-08 | 2023-06-06 | N |
| Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. | Health | 2023-05-04 | 2023-05-26 | N |
| Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2023-05-08 | 2023-05-26 | N |
| Develop Emergency Preparedness policies and procedures. | Fire Safety | 2023-05-08 | 2023-05-26 | N |
| Address subsistence needs for staff and patients. | Fire Safety | 2023-05-08 | 2023-05-26 | N |
| Establish roles under a Waiver declared by secretary. | Fire Safety | 2023-05-08 | 2023-05-26 | N |
| Develop a communication plan. | Fire Safety | 2023-05-08 | 2023-05-26 | N |
| Establish staff and initial training requirements. | Fire Safety | 2023-05-08 | 2023-05-26 | N |
| Have an enclosure around a vertical opening shaft. | Fire Safety | 2023-05-08 | 2023-05-26 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2023-05-08 | 2023-05-26 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-05-08 | 2023-05-26 | N |
| Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2023-05-08 | 2023-05-26 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2023-05-08 | 2023-05-26 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2023-05-08 | 2023-05-26 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2023-05-08 | 2023-05-26 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-05-08 | 2023-05-26 | N |
| Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk. | Fire Safety | 2023-05-08 | 2023-05-26 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2023-05-04 | 2023-05-23 | N |
| Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | Health | 2023-05-04 | 2023-05-23 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-05-04 | 2023-05-23 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2023-05-04 | 2023-05-23 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-05-04 | 2023-05-23 | N |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2023-05-04 | 2023-05-23 | N |
| Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. | Health | 2023-05-04 | 2023-05-23 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2023-05-04 | 2023-05-23 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2023-05-04 | 2023-05-23 | N |
| Protect each resident from the wrongful use of the resident's belongings or money. | Health | 2022-10-13 | 2022-10-25 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2022-10-13 | 2022-10-25 | Y |
| Respond appropriately to all alleged violations. | Health | 2022-10-13 | 2022-10-25 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-10-13 | 2022-10-25 | Y |
| Provide and implement an infection prevention and control program. | Health | 2022-02-09 | 2022-03-05 | N |
| Address patient/client population and determine types of services needed. | Fire Safety | 2022-02-16 | 2022-03-04 | N |
| Develop Emergency Preparedness policies and procedures. | Fire Safety | 2022-02-16 | 2022-03-04 | N |
| Establish emergency prep training and testing. | Fire Safety | 2022-02-16 | 2022-03-04 | N |
| Conduct testing and exercise requirements. | Fire Safety | 2022-02-16 | 2022-03-04 | N |
| Implement emergency and standby power systems. | Fire Safety | 2022-02-16 | 2022-03-04 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2022-02-16 | 2022-03-04 | N |
| Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk. | Fire Safety | 2022-02-16 | 2022-03-04 | N |
| Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | Health | 2022-02-09 | 2022-02-25 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-02-09 | 2022-02-25 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-02-09 | 2022-02-25 | 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 | 2022-02-09 | 2022-02-25 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-02-09 | 2022-02-25 | 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 | 2022-02-09 | 2022-02-25 | 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 | 2022-02-09 | 2022-02-25 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2022-02-09 | 2022-02-25 | N |
| Address patient/client population and determine types of services needed. | Fire Safety | 2021-05-18 | 2021-06-17 | N |
| Address subsistence needs for staff and patients. | Fire Safety | 2021-05-18 | 2021-06-17 | N |
| Establish policies and procedures for sheltering. | Fire Safety | 2021-05-18 | 2021-06-17 | N |
| Provide emergency officials' contact information. | Fire Safety | 2021-05-18 | 2021-06-17 | N |
| Implement emergency and standby power systems. | Fire Safety | 2021-05-18 | 2021-06-17 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2021-05-18 | 2021-06-17 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2021-05-18 | 2021-06-17 | N |
| Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | Health | 2021-05-06 | 2021-05-17 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2021-05-06 | 2021-05-17 | 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 | 2021-05-06 | 2021-05-17 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2021-05-06 | 2021-05-17 | N |
