A list of the most recent deficiencies for Lakewood Nrsg and Rehab Center. 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 elevators that firefighters can control in the event of a fire. | Fire Safety | 2023-04-19 | 2023-05-10 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-04-19 | 2023-05-04 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2023-04-19 | 2023-04-20 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-04-19 | 2023-04-20 | N |
| Keep residents' personal and medical records private and confidential. | Health | 2023-04-13 | 2023-04-18 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-04-13 | 2023-04-18 | 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 | 2023-04-13 | 2023-04-18 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-04-13 | 2023-04-18 | 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 | 2023-04-13 | 2023-04-18 | N |
| Provide for the safe, appropriate administration of IV fluids for a resident when needed. | Health | 2023-04-13 | 2023-04-18 | 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 | 2023-04-13 | 2023-04-18 | 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 | 2023-04-13 | 2023-04-18 | N |
| Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. | Health | 2023-04-13 | 2023-04-18 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-04-13 | 2023-04-18 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-04-13 | 2023-04-18 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2023-04-13 | 2023-04-18 | 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 | 2022-08-26 | 2022-08-29 | Y |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-03-16 | 2022-04-15 | N |
| Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2022-03-16 | 2022-03-18 | N |
| Address patient/client population and determine types of services needed. | Fire Safety | 2022-03-16 | 2022-03-18 | N |
| Develop Emergency Preparedness policies and procedures. | Fire Safety | 2022-03-16 | 2022-03-18 | N |
| Develop a communication plan. | Fire Safety | 2022-03-16 | 2022-03-18 | N |
| Establish emergency prep training and testing. | Fire Safety | 2022-03-16 | 2022-03-18 | N |
| Install a two-hour-resistant firewall separation. | Fire Safety | 2022-03-16 | 2022-03-18 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2022-03-16 | 2022-03-18 | 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 | 2022-03-16 | 2022-03-18 | N |
| Install a fire alarm system that can be heard throughout the facility. | Fire Safety | 2022-03-16 | 2022-03-18 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2022-03-16 | 2022-03-18 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2022-03-16 | 2022-03-18 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2022-03-16 | 2022-03-18 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2022-03-16 | 2022-03-18 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2022-03-16 | 2022-03-18 | N |
| Have proper power supply for life support equipment. | Fire Safety | 2022-03-16 | 2022-03-18 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2022-03-16 | 2022-03-18 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2022-03-16 | 2022-03-18 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2022-03-10 | 2022-03-15 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2022-03-10 | 2022-03-15 | N |
| Have a policy regarding use and storage of foods brought to residents by family and other visitors. | Health | 2022-03-10 | 2022-03-15 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-03-10 | 2022-03-15 | N |
| Address patient/client population and determine types of services needed. | Fire Safety | 2021-02-11 | 2021-03-05 | N |
| Establish policies and procedures for volunteers. | Fire Safety | 2021-02-11 | 2021-03-05 | N |
| Establish methods for sharing information. | Fire Safety | 2021-02-11 | 2021-02-24 | 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 | 2021-02-11 | 2021-02-24 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2021-02-11 | 2021-02-24 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2021-02-11 | 2021-02-24 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2021-02-11 | 2021-02-24 | N |
| Provide family notifications of emergency plan. | Fire Safety | 2021-02-11 | 2021-02-12 | N |
| Conduct testing and exercise requirements. | Fire Safety | 2021-02-11 | 2021-02-12 | N |
| Implement emergency and standby power systems. | Fire Safety | 2021-02-11 | 2021-02-12 | 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 | 2021-02-11 | 2021-02-11 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2021-02-11 | 2021-02-11 | N |
