A list of the most recent deficiencies for Odd Fellow-Rebekah Home. 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 care and assistance to perform activities of daily living for any resident who is unable. | Health | 2024-01-31 | 2024-02-20 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2023-12-06 | 2024-01-25 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2023-12-06 | 2024-01-25 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-12-06 | 2024-01-25 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2023-12-06 | 2024-01-25 | 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 | 2023-12-06 | 2024-01-25 | N |
| Ensure each resident must receive and the facility must provide necessary behavioral health care and services. | Health | 2023-12-06 | 2024-01-25 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2023-12-06 | 2024-01-25 | N |
| Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. | Health | 2023-12-06 | 2024-01-25 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-12-06 | 2024-01-25 | N |
| Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | Health | 2023-12-06 | 2023-12-28 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2023-12-06 | 2023-12-28 | N |
| Notify the resident or the resident?s representative in writing how long the nursing home will hold the resident?s bed in cases of transfer to a hospital or therapeutic leave. | Health | 2023-12-06 | 2023-12-28 | 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 | 2023-12-06 | 2023-12-28 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-12-06 | 2023-12-28 | 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 | 2023-12-06 | 2023-12-28 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-12-06 | 2023-12-28 | N |
| Provide emergency officials' contact information. | Fire Safety | 2023-12-06 | 2023-12-26 | N |
| Establish methods for sharing information. | Fire Safety | 2023-12-06 | 2023-12-26 | N |
| Follow proper procedures when the fire alarm was out of service for more than 4 hours. | Fire Safety | 2023-12-06 | 2023-12-26 | N |
| Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2023-12-06 | 2023-12-26 | N |
| Ensure each resident receives an accurate assessment. | Health | 2023-11-01 | 2023-11-21 | Y |
| 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 | 2023-11-01 | 2023-11-21 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2023-08-31 | 2023-09-13 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-08-31 | 2023-09-13 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-03-27 | 2023-04-12 | Y |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2023-02-02 | 2023-03-07 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2023-02-03 | 2023-02-23 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-02-03 | 2023-02-23 | 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 | 2023-02-03 | 2023-02-23 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-02-03 | 2023-02-23 | N |
| Ensure staff are vaccinated for COVID-19 | Health | 2023-02-03 | 2023-02-23 | N |
| Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame. | Health | 2023-02-03 | 2023-02-23 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-02-02 | 2023-02-23 | N |
| Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2023-02-02 | 2023-02-23 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-12-16 | 2023-01-05 | Y |
| 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 | 2022-11-09 | 2022-12-01 | Y |
| Implement a program that monitors antibiotic use. | Health | 2022-11-09 | 2022-12-01 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-08-18 | 2022-10-12 | Y |
| Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made. | Health | 2022-09-18 | 2022-09-29 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-09-18 | 2022-09-29 | Y |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2022-05-20 | 2022-06-10 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2022-05-20 | 2022-06-10 | N |
| Have proper power supply for life support equipment. | Fire Safety | 2022-05-20 | 2022-06-10 | N |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2022-04-28 | 2022-05-18 | N |
| Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | Health | 2022-04-28 | 2022-05-18 | N |
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2022-04-28 | 2022-05-18 | 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 | 2022-04-28 | 2022-05-18 | N |
| Ensure that residents are free from significant medication errors. | Health | 2022-04-28 | 2022-05-18 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2022-02-23 | 2022-03-16 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-02-23 | 2022-03-16 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2021-10-04 | 2021-10-26 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2021-08-16 | 2021-08-23 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-08-04 | 2021-08-12 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2021-04-21 | 2021-05-07 | Y |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2021-04-21 | 2021-05-07 | Y |
