Deficiency Records for Wellbrooke of South Bend
Updated as of March 01, 2022
This is not the most recent data for Wellbrooke of South Bend. For the most recent information, click here.
A list of the most recent deficiencies for Wellbrooke of South Bend. 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 and implement an infection prevention and control program. | Health | 2021-12-06 | 2021-12-23 | N |
| Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. | Health | 2021-03-02 | 2021-03-15 | Y |
| Have restrictions on the use of highly flammable decorations. | Fire Safety | 2019-06-13 | 2019-06-28 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2019-06-13 | 2019-06-28 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2019-06-13 | 2019-06-28 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2019-06-13 | 2019-06-28 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2019-04-29 | 2019-05-18 | 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 | 2019-04-29 | 2019-05-18 | N |
| Implement a program that monitors antibiotic use. | Health | 2019-04-29 | 2019-05-18 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2019-04-29 | 2019-05-18 | N |
| Address patient/client population and determine types of services needed. | Fire Safety | 2018-03-27 | 2018-06-04 | N |
| Provide family notifications of emergency plan. | Fire Safety | 2018-03-27 | 2018-06-04 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2018-03-27 | 2018-06-04 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2018-03-27 | 2018-06-04 | N |
| Establish policies and procedures for medical documentation. | Fire Safety | 2018-03-27 | 2018-04-26 | N |
| Establish policies and procedures for volunteers. | Fire Safety | 2018-03-27 | 2018-04-26 | N |
| Provide a means of sharing information on occupancy/needs. | Fire Safety | 2018-03-27 | 2018-04-26 | 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 | 2018-03-27 | 2018-04-26 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2018-03-27 | 2018-04-26 | 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 | 2018-03-27 | 2018-04-26 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2018-03-27 | 2018-04-26 | N |
| Have elevators that firefighters can control in the event of a fire. | Fire Safety | 2018-03-27 | 2018-04-26 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2018-03-27 | 2018-04-26 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2018-03-27 | 2018-04-26 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2018-03-27 | 2018-04-26 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2018-03-27 | 2018-04-26 | N |
| Have proper fire barriers, ventilation and signs for the transfilling of oxygen. | Fire Safety | 2018-03-27 | 2018-04-26 | N |
| 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 | 2018-02-20 | 2018-03-22 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2018-02-20 | 2018-03-22 | 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 | 2018-02-20 | 2018-03-22 | N |
| Provide safe, appropriate pain management for a resident who requires such services. | Health | 2018-02-20 | 2018-03-22 | 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 | 2018-02-20 | 2018-03-22 | N |
| Provide and implement an infection prevention and control program. | Health | 2018-02-20 | 2018-03-22 | N |
| Install a fire alarm system that can be heard throughout the facility. | Fire Safety | 2017-01-17 | 2017-02-16 | N |
| Follow proper procedures when the fire alarm was out of service for more than 4 hours. | Fire Safety | 2017-01-17 | 2017-02-16 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2017-01-17 | 2017-02-16 | N |
| Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2017-01-17 | 2017-02-16 | N |
| Have restrictions on the use of highly flammable decorations. | Fire Safety | 2017-01-17 | 2017-02-16 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2017-01-17 | 2017-02-16 | N |
| Protect each resident from all abuse, physical punishment, and involuntary separation from others. | Health | 2016-12-21 | 2017-01-20 | N |
| 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 | 2016-12-21 | 2017-01-20 | N |
| 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 | 2016-12-21 | 2017-01-20 | N |
| Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2016-12-21 | 2017-01-20 | N |
| Provide care by qualified persons according to each resident's written plan of care. | Health | 2016-12-21 | 2017-01-20 | N |
| 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 | 2016-12-21 | 2017-01-20 | N |
| Have a program that investigates, controls and keeps infection from spreading. | Health | 2016-12-21 | 2017-01-20 | N |
