Deficiency Records for Accura Healthcare of Pleasantville, LLC
Updated as of March 01, 2024
A list of the most recent deficiencies for Accura Healthcare of Pleasantville, LLC. 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 | 2023-08-01 | 2023-08-02 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-06-01 | 2023-08-02 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-06-01 | 2023-06-02 | Y |
| Conduct testing and exercise requirements. | Fire Safety | 2023-03-23 | 2023-04-21 | N |
| Install proper backup exit lighting. | Fire Safety | 2023-03-23 | 2023-04-21 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2023-03-23 | 2023-04-21 | 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 | 2023-03-23 | 2023-04-21 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2023-03-23 | 2023-04-21 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2023-03-23 | 2023-04-21 | N |
| Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2023-03-23 | 2023-04-21 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2023-03-23 | 2023-04-21 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2023-03-23 | 2023-04-21 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2023-03-23 | 2023-04-21 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-03-23 | 2023-04-21 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2023-03-23 | 2023-04-21 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2023-03-23 | 2023-04-21 | N |
| Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk. | Fire Safety | 2023-03-23 | 2023-04-21 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2023-03-30 | 2023-04-20 | N |
| Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | Health | 2023-03-30 | 2023-04-20 | N |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2023-03-30 | 2023-04-20 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-03-30 | 2023-04-20 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2023-03-30 | 2023-04-20 | 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 | 2023-03-30 | 2023-04-20 | N |
| Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | Health | 2023-03-30 | 2023-04-20 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-03-30 | 2023-04-20 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2023-03-30 | 2023-04-20 | N |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2023-03-30 | 2023-04-20 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2023-03-30 | 2023-04-20 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2023-03-30 | 2023-04-20 | Y |
| Respond appropriately to all alleged violations. | Health | 2023-03-30 | 2023-04-20 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-03-30 | 2023-04-20 | Y |
| Have enough outside ventilation via a window or mechanical ventilation, or both. | Health | 2023-03-30 | 2023-04-20 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-09-28 | 2022-09-28 | 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 | 2022-09-28 | 2022-09-28 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2022-05-17 | 2022-06-03 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2022-05-17 | 2022-06-03 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2022-05-17 | 2022-06-03 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-05-17 | 2022-06-03 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2022-05-17 | 2022-06-03 | 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 | 2022-05-17 | 2022-06-03 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-05-17 | 2022-06-03 | Y |
| Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. | Health | 2022-05-17 | 2022-06-03 | Y |
| Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | Health | 2022-05-17 | 2022-06-03 | Y |
| Provide and implement an infection prevention and control program. | Health | 2022-05-17 | 2022-06-03 | Y |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2021-12-16 | 2022-01-19 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2021-12-16 | 2022-01-19 | N |
| Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home. | Health | 2022-01-06 | 2022-01-17 | N |
| Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. | Health | 2022-01-06 | 2022-01-17 | N |
| Assess the resident when there is a significant change in condition | Health | 2022-01-06 | 2022-01-17 | N |
| Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. | Health | 2022-01-06 | 2022-01-17 | 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 | 2022-01-06 | 2022-01-17 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-01-06 | 2022-01-17 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2022-01-06 | 2022-01-17 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2022-01-06 | 2022-01-17 | N |
| Post nurse staffing information every day. | Health | 2022-01-06 | 2022-01-17 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2022-01-06 | 2022-01-17 | N |
| Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. | Health | 2022-01-06 | 2022-01-17 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-01-06 | 2022-01-17 | N |
| Employ staff that are licensed, certified, or registered in accordance with state laws. | Health | 2022-01-06 | 2022-01-17 | N |
| Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | Health | 2022-01-06 | 2022-01-17 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-01-06 | 2022-01-17 | 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 | 2022-01-06 | 2022-01-17 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2022-01-06 | 2022-01-17 | Y |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2022-01-06 | 2022-01-17 | Y |
| 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 | 2022-01-06 | 2022-01-17 | Y |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2022-01-06 | 2022-01-17 | 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 | 2021-12-16 | 2022-01-16 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2021-12-16 | 2022-01-16 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2021-12-16 | 2022-01-16 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2021-12-16 | 2022-01-16 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2021-12-16 | 2022-01-16 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2021-12-16 | 2022-01-16 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-01-06 | 2022-01-06 | Y |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2021-12-16 | 2021-12-29 | N |
| Use approved construction type or materials. | Fire Safety | 2021-12-16 | 2021-12-28 | N |
| List the names and contact information of those in the facility. | Fire Safety | 2021-12-16 | 2021-12-27 | N |
| Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2021-12-16 | 2021-12-27 | N |
| Install proper backup exit lighting. | Fire Safety | 2021-12-16 | 2021-12-23 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2021-12-16 | 2021-12-16 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2019-09-09 | 2019-10-17 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2019-09-05 | 2019-09-30 | N |
| Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. | Health | 2019-09-05 | 2019-09-30 | 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 | 2019-09-05 | 2019-09-30 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2019-09-05 | 2019-09-30 | N |
| Provide activities to meet all resident's needs. | Health | 2019-09-05 | 2019-09-30 | 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 | 2019-09-05 | 2019-09-30 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2019-09-05 | 2019-09-30 | 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 | 2019-09-05 | 2019-09-30 | N |
| Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. | Health | 2019-09-05 | 2019-09-30 | N |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2019-09-05 | 2019-09-30 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2019-09-05 | 2019-09-30 | N |
| Provide and implement an infection prevention and control program. | Health | 2019-09-05 | 2019-09-30 | N |
| Establish procedures for tracking staff and patients during an emergency. | Fire Safety | 2019-09-09 | 2019-09-25 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2019-09-09 | 2019-09-09 | N |
