A list of the most recent deficiencies for Meadowbrook Rehabilitation Hospital. 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 | 2023-03-01 | 2023-03-28 | Y |
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. | Health | 2023-01-18 | 2023-01-18 | Y |
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2022-12-27 | 2023-01-16 | Y |
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | Health | 2022-12-27 | 2023-01-16 | Y |
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-01-18 | 2023-01-04 | Y |
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-12-08 | 2023-01-03 | Y |
Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. | Health | 2022-12-08 | 2023-01-03 | Y |
Make sure that a working call system is available in each resident's bathroom and bathing area. | Health | 2022-12-08 | 2023-01-03 | Y |
Provide and implement an infection prevention and control program. | Health | 2022-07-25 | 2022-08-22 | Y |
To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2022-04-06 | 2022-06-16 | N |
Reasonably accommodate the needs and preferences of each resident. | Health | 2022-03-16 | 2022-04-21 | Y |
Ensure each resident receives an accurate assessment. | Health | 2022-03-16 | 2022-04-21 | 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 | 2022-03-16 | 2022-04-21 | Y |
Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-03-16 | 2022-04-21 | 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 | 2022-03-16 | 2022-04-21 | Y |
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | Health | 2022-03-16 | 2022-04-21 | Y |
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 | 2022-03-16 | 2022-04-21 | Y |
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-03-16 | 2022-04-21 | Y |
Provide and implement an infection prevention and control program. | Health | 2022-03-16 | 2022-04-21 | Y |
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 | 2022-04-06 | 2022-04-18 | N |
Install an approved automatic sprinkler system. | Fire Safety | 2022-04-06 | 2022-04-18 | N |
Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2022-04-06 | 2022-04-18 | N |
Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2022-04-06 | 2022-04-18 | N |
Have simulated fire drills held at unexpected times. | Fire Safety | 2022-04-06 | 2022-04-18 | 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 | 2021-02-17 | 2021-03-18 | N |
Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2021-02-17 | 2021-03-18 | N |
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | Health | 2021-02-17 | 2021-03-18 | N |
Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2021-02-17 | 2021-03-18 | 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 | 2021-02-17 | 2021-03-18 | N |
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2021-02-17 | 2021-03-18 | N |
Provide and implement an infection prevention and control program. | Health | 2021-02-17 | 2021-03-18 | N |
Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2020-03-17 | 2020-05-07 | N |
Establish policies and procedures for volunteers. | Fire Safety | 2020-03-17 | 2020-05-07 | N |
Establish roles under a Waiver declared by secretary. | Fire Safety | 2020-03-17 | 2020-05-07 | N |
Use approved construction type or materials. | Fire Safety | 2020-03-17 | 2020-05-07 | N |
Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2020-03-17 | 2020-05-07 | 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 | 2020-03-17 | 2020-05-07 | N |
Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2020-03-17 | 2020-05-07 | N |
Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2020-03-17 | 2020-05-07 | N |
Have simulated fire drills held at unexpected times. | Fire Safety | 2020-03-17 | 2020-05-07 | N |
To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2020-03-17 | 2020-05-07 | N |
Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2020-03-17 | 2020-05-07 | N |
Ensure proper usage of power strips and extension cords. | Fire Safety | 2020-03-17 | 2020-05-07 | N |
Have proper medical gas storage and administration areas. | Fire Safety | 2020-03-17 | 2020-05-07 | N |
Give the resident's representative the ability to exercise the resident's rights. | Health | 2019-04-25 | 2019-06-05 | N |
Encode each resident?s assessment data and transmit these data to the State within 7 days of assessment. | Health | 2019-04-25 | 2019-06-05 | N |
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2019-04-25 | 2019-06-05 | N |
Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2019-04-25 | 2019-06-05 | N |
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | Health | 2019-04-25 | 2019-06-05 | N |
Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2019-04-25 | 2019-06-05 | 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 | 2019-04-25 | 2019-06-05 | N |
Create arrangements with other facilities to receive patients. | Fire Safety | 2018-12-13 | 2019-01-07 | N |
Develop a communication plan. | Fire Safety | 2018-12-13 | 2019-01-07 | 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 | 2018-12-13 | 2019-01-07 | N |
Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2018-12-13 | 2019-01-07 | N |
Have restrictions on the use of portable space heaters. | Fire Safety | 2018-12-13 | 2019-01-07 | N |