A list of the most recent deficiencies for University Nsg 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? |
|---|---|---|---|---|
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2024-01-31 | 2024-02-15 | N |
| Protect each resident from the wrongful use of the resident's belongings or money. | Health | 2024-01-31 | 2024-02-15 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2024-01-31 | 2024-02-15 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2024-01-31 | 2024-02-15 | 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 | 2024-01-31 | 2024-02-15 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2024-01-31 | 2024-02-15 | N |
| Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. | Health | 2024-01-31 | 2024-02-15 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2024-02-02 | 2024-02-15 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2024-02-02 | 2024-02-15 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2024-02-02 | 2024-02-15 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2024-02-02 | 2024-02-15 | 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 | 2023-12-05 | 2023-12-07 | 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 | 2023-11-22 | 2023-11-27 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-11-02 | 2023-11-06 | Y |
| Provide and implement an infection prevention and control program. | Health | 2023-11-02 | 2023-11-06 | Y |
| Ensure that residents are free from significant medication errors. | Health | 2023-10-18 | 2023-10-27 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2023-10-05 | 2023-10-06 | Y |
| 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 | 2023-10-05 | 2023-10-06 | Y |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2023-10-05 | 2023-10-06 | Y |
| 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 | 2023-09-19 | 2023-09-22 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-09-19 | 2023-09-22 | Y |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2023-07-21 | 2023-07-22 | 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 | 2023-07-21 | 2023-07-22 | 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 | 2023-05-08 | 2023-05-17 | Y |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2023-05-10 | 2023-05-11 | Y |
| Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2023-04-14 | 2023-04-27 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2023-04-14 | 2023-04-27 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2023-04-14 | 2023-04-27 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-04-14 | 2023-04-27 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2023-04-14 | 2023-04-27 | N |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2023-03-17 | 2023-03-29 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2023-03-17 | 2023-03-29 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-03-17 | 2023-03-29 | 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 | 2023-03-17 | 2023-03-29 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-03-17 | 2023-03-29 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-09-20 | 2022-09-28 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-09-20 | 2022-09-28 | Y |
| 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 | 2022-08-23 | 2022-09-09 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-05-31 | 2022-06-10 | Y |
| Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | Health | 2022-05-12 | 2022-05-19 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2022-05-12 | 2022-05-19 | Y |
| Respond appropriately to all alleged violations. | Health | 2022-05-12 | 2022-05-19 | Y |
| Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. | Fire Safety | 2022-04-22 | 2022-04-29 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-04-22 | 2022-04-29 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2022-04-22 | 2022-04-29 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2022-04-22 | 2022-04-29 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2022-04-22 | 2022-04-29 | N |
| Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | Health | 2022-04-08 | 2022-04-22 | 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 | 2022-04-08 | 2022-04-22 | 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 | 2022-04-22 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-04-08 | 2022-04-22 | N |
| Implement a program that monitors antibiotic use. | Health | 2022-04-08 | 2022-04-22 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-11-17 | 2021-12-01 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-10-29 | 2021-12-01 | Y |
| Respond appropriately to all alleged violations. | Health | 2021-10-29 | 2021-11-12 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2021-08-06 | 2021-08-12 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2021-07-16 | 2021-08-08 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-07-16 | 2021-08-08 | Y |
