A list of the most recent deficiencies for The Pearl of Montclare. 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? |
|---|---|---|---|---|
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-11-17 | 2023-12-07 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2023-09-10 | 2023-10-02 | Y |
| Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. | Health | 2023-09-10 | 2023-10-02 | Y |
| 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 | 2023-09-10 | 2023-10-02 | Y |
| Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy. | Health | 2023-09-10 | 2023-10-02 | Y |
| Provide and implement an infection prevention and control program. | Health | 2023-09-10 | 2023-09-26 | Y |
| Conduct testing and exercise requirements. | Fire Safety | 2023-05-09 | 2023-05-31 | N |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-05-05 | 2023-05-26 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2023-05-05 | 2023-05-26 | N |
| Respond appropriately to all alleged violations. | Health | 2023-05-05 | 2023-05-26 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-05-05 | 2023-05-26 | 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 | 2023-05-05 | 2023-05-26 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-05-05 | 2023-05-26 | N |
| Dispose of garbage and refuse properly. | Health | 2023-05-05 | 2023-05-26 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-05-05 | 2023-05-26 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2023-05-05 | 2023-05-26 | N |
| Perform COVID19 testing on residents and staff. | Health | 2023-05-05 | 2023-05-26 | N |
| Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. | Health | 2023-05-05 | 2023-05-26 | N |
| Ensure staff are vaccinated for COVID-19 | Health | 2023-05-05 | 2023-05-26 | N |
| Install a two-hour-resistant firewall separation. | Fire Safety | 2023-05-09 | 2023-05-26 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2023-05-09 | 2023-05-26 | N |
| Have properly located and lighted "Exit" signs. | Fire Safety | 2023-05-09 | 2023-05-26 | 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 | 2023-05-09 | 2023-05-26 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2023-05-09 | 2023-05-26 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-05-09 | 2023-05-26 | N |
| Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke. | Fire Safety | 2023-05-09 | 2023-05-26 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2023-05-09 | 2023-05-26 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2023-05-09 | 2023-05-26 | N |
| Have elevators that firefighters can control in the event of a fire. | Fire Safety | 2023-05-09 | 2023-05-26 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-05-09 | 2023-05-26 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-04-12 | 2023-05-01 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-04-12 | 2023-05-01 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-01-27 | 2023-02-24 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-01-27 | 2023-02-24 | Y |
| Have stairways and smokeproof enclosures used as exits that meet safety requirements. | Fire Safety | 2022-04-12 | 2022-05-16 | N |
| Have an enclosure around a vertical opening shaft. | Fire Safety | 2022-04-12 | 2022-05-16 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-04-12 | 2022-05-16 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2022-04-12 | 2022-05-16 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2022-04-12 | 2022-05-16 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2022-04-12 | 2022-05-16 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2022-04-12 | 2022-05-16 | N |
| Have restrictions on the use of portable space heaters. | Fire Safety | 2022-04-12 | 2022-05-16 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2022-04-12 | 2022-05-16 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2022-04-12 | 2022-05-16 | N |
| Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk. | Fire Safety | 2022-04-12 | 2022-05-16 | N |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2022-04-08 | 2022-05-09 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2022-04-08 | 2022-05-09 | 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 | 2022-04-08 | 2022-05-09 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2022-04-08 | 2022-05-09 | 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 | 2022-04-08 | 2022-05-09 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-04-08 | 2022-05-09 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-04-08 | 2022-05-09 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2022-04-08 | 2022-05-09 | 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 | 2022-04-04 | 2022-05-06 | Y |
| Respond appropriately to all alleged violations. | Health | 2021-10-29 | 2021-12-10 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2021-09-16 | 2021-10-25 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-09-16 | 2021-10-25 | Y |
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2021-07-01 | 2021-07-26 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2021-07-01 | 2021-07-26 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2021-07-01 | 2021-07-26 | Y |
| 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 | 2021-07-01 | 2021-07-26 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2021-05-20 | 2021-06-16 | Y |
| Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | Health | 2021-01-29 | 2021-03-15 | 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 | 2021-01-29 | 2021-03-15 | N |
| Address subsistence needs for staff and patients. | Fire Safety | 2021-02-03 | 2021-03-15 | N |
| Establish policies and procedures including evacuation. | Fire Safety | 2021-02-03 | 2021-03-15 | N |
| Establish policies and procedures for sheltering. | Fire Safety | 2021-02-03 | 2021-03-15 | N |
| Establish policies and procedures for medical documentation. | Fire Safety | 2021-02-03 | 2021-03-15 | N |
| Establish methods for sharing information. | Fire Safety | 2021-02-03 | 2021-03-15 | N |
| Establish staff and initial training requirements. | Fire Safety | 2021-02-03 | 2021-03-15 | N |
| Implement emergency and standby power systems. | Fire Safety | 2021-02-03 | 2021-03-15 | 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 | 2021-02-03 | 2021-03-15 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2021-02-03 | 2021-03-15 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2021-02-03 | 2021-03-15 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2021-02-03 | 2021-03-15 | N |
