Deficiency Records for Addison Pointe Health and Rehabilitation Center
Updated as of February 01, 2020
This is not the most recent data for Addison Pointe Health and Rehabilitation Center. For the most recent information, click here.
A list of the most recent deficiencies for Addison Pointe Health and Rehabilitation 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? |
|---|---|---|---|---|
| Conduct risk assessment and an All-Hazards approach. | Fire Safety | 2019-08-13 | 2019-09-12 | N |
| Include a process for Emergency Preparedness collaboration. | Fire Safety | 2019-08-13 | 2019-09-12 | 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 | 2019-08-13 | 2019-09-12 | N |
| Provide a written emergency evacuation plan. | Fire Safety | 2019-08-13 | 2019-09-12 | N |
| Have restrictions on the use of highly flammable decorations. | Fire Safety | 2019-08-13 | 2019-09-12 | N |
| Allow residents to easily view the nursing home's survey results and communicate with advocate agencies. | Health | 2019-06-28 | 2019-07-28 | N |
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2019-06-28 | 2019-07-28 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2019-06-28 | 2019-07-28 | 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 | 2019-06-28 | 2019-07-28 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2019-06-28 | 2019-07-28 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2019-06-28 | 2019-07-28 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2019-06-28 | 2019-07-28 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2019-06-28 | 2019-07-28 | N |
| Ensure that residents are free from significant medication errors. | Health | 2019-06-28 | 2019-07-28 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2019-06-28 | 2019-07-28 | N |
| Provide and implement an infection prevention and control program. | Health | 2019-06-28 | 2019-07-28 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2019-06-04 | 2019-07-04 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2018-06-27 | 2018-07-27 | Y |
| Address patient/client population and determine types of services needed. | Fire Safety | 2018-05-30 | 2018-06-25 | 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 | 2018-05-30 | 2018-06-25 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2018-05-30 | 2018-06-25 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2018-05-30 | 2018-06-25 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2018-04-30 | 2018-06-14 | N |
| Provide and implement an infection prevention and control program. | Health | 2018-04-30 | 2018-06-14 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2018-04-30 | 2018-05-30 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2018-04-30 | 2018-05-30 | N |
| Assist a resident in gaining access to vision and hearing services. | Health | 2018-04-30 | 2018-05-30 | 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 | 2018-04-30 | 2018-05-30 | 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 ne | Health | 2018-04-30 | 2018-05-30 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2018-04-30 | 2018-05-30 | 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 | 2018-04-30 | 2018-05-30 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2018-04-30 | 2018-05-30 | N |
| Implement a program that monitors antibiotic use. | Health | 2018-04-30 | 2018-05-30 | N |
| Provide necessary care and services to maintain or improve the highest well being of each resident . | Health | 2017-10-27 | 2017-12-06 | Y |
| 1) Hire only people with no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents. | Health | 2017-08-22 | 2017-09-21 | Y |
| Develop and implement policies for 1) screening and training employees; and the 2) prevention, identification, investigation, and reporting of any abuse, neglect, mistreatment and misappropriation of property. | Health | 2017-08-22 | 2017-09-21 | Y |
| Ensure that each resident who enters the nursing home without a catheter is not given a catheter, unless medically necessary, and that incontinent patients receive proper services to prevent urinary tract infections and restore normal bladder functions. | Health | 2017-06-23 | 2017-07-23 | Y |
| Give or get quality laboratory services/tests in a timely manner to meet the needs of residents. | Health | 2017-05-09 | 2017-06-06 | Y |
| Quickly tell the resident's doctor the results of laboratory tests. | Health | 2017-05-09 | 2017-06-06 | Y |
| Have a correctly designed non-healthcare occupancy area in a health care facility. | Fire Safety | 2017-05-02 | 2017-05-26 | 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 | 2017-05-02 | 2017-05-26 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2017-05-02 | 2017-05-26 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2017-05-02 | 2017-05-26 | N |
| Maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards. | Health | 2017-04-03 | 2017-05-03 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2017-04-03 | 2017-05-03 | Y |
| 1) Hire only people with no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents. | Health | 2017-04-03 | 2017-05-03 | Y |
| Develop and implement policies for 1) screening and training employees; and the 2) prevention, identification, investigation, and reporting of any abuse, neglect, mistreatment and misappropriation of property. | Health | 2017-04-03 | 2017-05-03 | Y |
| Ensure residents have the right to have a choice over activities, their schedules, and health care according to their interests, assessments, and plans of care. | Health | 2017-04-03 | 2017-05-03 | Y |
| Provide care by qualified persons according to each resident's written plan of care. | Health | 2017-04-03 | 2017-05-03 | Y |
| Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. | Health | 2017-04-03 | 2017-05-03 | Y |
| Ensure that each resident's 1) entire drug/medication regimen is free from unnecessary drugs; and 2) is managed and monitored to achieve highest level of well-being. | Health | 2017-04-03 | 2017-05-03 | Y |
| Store, cook, and serve food in a safe and clean way. | Health | 2017-04-03 | 2017-05-03 | Y |
| Provide care by qualified persons according to each resident's written plan of care. | Health | 2017-02-09 | 2017-03-09 | Y |
