A list of the most recent deficiencies for Medicalodges Post Acute Care 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? |
|---|---|---|---|---|
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2023-05-22 | 2023-06-21 | N |
| Have properly located and lighted "Exit" signs. | Fire Safety | 2023-05-22 | 2023-06-21 | N |
| Have properly installed hallway dispensers for alcohol-based hand rub. | Fire Safety | 2023-05-22 | 2023-06-21 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2023-05-22 | 2023-06-21 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2023-05-22 | 2023-06-21 | N |
| Have restrictions on the use of highly flammable decorations. | Fire Safety | 2023-05-22 | 2023-06-21 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2023-05-22 | 2023-06-21 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2023-05-22 | 2023-06-21 | N |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-06-12 | 2023-06-02 | Y |
| Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | Health | 2023-05-04 | 2023-06-01 | N |
| Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | Health | 2023-05-04 | 2023-06-01 | N |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-05-04 | 2023-06-01 | N |
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2023-05-04 | 2023-06-01 | N |
| Plan the resident's discharge to meet the resident's goals and needs. | Health | 2023-05-04 | 2023-06-01 | N |
| Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. | Health | 2023-05-04 | 2023-06-01 | N |
| Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | Health | 2023-05-04 | 2023-06-01 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-05-04 | 2023-06-01 | N |
| Provide activities to meet all resident's needs. | Health | 2023-05-04 | 2023-06-01 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2023-05-04 | 2023-06-01 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-05-04 | 2023-06-01 | 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 | 2023-05-04 | 2023-06-01 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2023-05-04 | 2023-06-01 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-05-04 | 2023-06-01 | N |
| Post nurse staffing information every day. | Health | 2023-05-04 | 2023-06-01 | N |
| Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. | Health | 2023-05-04 | 2023-06-01 | 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 | 2023-05-04 | 2023-06-01 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2023-05-04 | 2023-06-01 | 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 | 2023-05-04 | 2023-06-01 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-05-04 | 2023-06-01 | N |
| Have a plan that describes the process for conducting QAPI and QAA activities. | Health | 2023-05-04 | 2023-06-01 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-05-04 | 2023-06-01 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2023-05-04 | 2023-06-01 | N |
| Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. | Health | 2023-05-04 | 2023-06-01 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-03-30 | 2023-03-30 | Y |
| Make sure that a working call system is available in each resident's bathroom and bathing area. | Health | 2023-03-09 | 2023-03-20 | Y |
| Ensure each resident must receive and the facility must provide necessary behavioral health care and services. | Health | 2022-10-24 | 2022-11-23 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-06-14 | 2022-06-24 | Y |
| Protect each resident from the wrongful use of the resident's belongings or money. | Health | 2021-11-23 | 2021-11-24 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2021-11-23 | 2021-11-24 | Y |
| Respond appropriately to all alleged violations. | Health | 2021-11-23 | 2021-11-24 | Y |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2021-10-13 | 2021-11-21 | N |
| Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | Health | 2021-10-13 | 2021-11-21 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2021-10-13 | 2021-11-21 | N |
| Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. | Health | 2021-10-13 | 2021-11-21 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2021-10-13 | 2021-11-21 | 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 | 2021-10-13 | 2021-11-21 | 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 | 2021-10-13 | 2021-11-21 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2021-10-13 | 2021-11-21 | N |
| Post nurse staffing information every day. | Health | 2021-10-13 | 2021-11-21 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2021-10-13 | 2021-11-21 | 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 | 2021-10-13 | 2021-11-21 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2021-10-13 | 2021-11-21 | 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 | 2021-10-13 | 2021-11-21 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2021-10-13 | 2021-11-21 | N |
| 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 | 2021-10-13 | 2021-11-21 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2021-10-13 | 2021-11-21 | 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 | 2021-10-13 | 2021-11-21 | Y |
| Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | Health | 2021-10-13 | 2021-11-21 | Y |
| Provide and implement an infection prevention and control program. | Health | 2021-10-13 | 2021-11-21 | Y |
| Implement a program that monitors antibiotic use. | Health | 2021-10-13 | 2021-11-21 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-08-18 | 2021-09-28 | Y |
| Include a process for Emergency Preparedness collaboration. | Fire Safety | 2021-08-25 | 2021-09-28 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2021-08-25 | 2021-09-28 | 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 | 2021-08-25 | 2021-09-28 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2021-08-25 | 2021-09-28 | 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 | 2021-08-25 | 2021-09-28 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2021-08-25 | 2021-09-28 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2021-08-25 | 2021-09-28 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2021-08-25 | 2021-09-28 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2021-08-25 | 2021-09-28 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2021-08-25 | 2021-09-28 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2021-08-25 | 2021-09-28 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2021-08-25 | 2021-09-28 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2021-08-25 | 2021-09-28 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2021-08-25 | 2021-09-28 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2021-08-25 | 2021-09-28 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2021-08-25 | 2021-09-28 | N |
| Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | Health | 2019-11-07 | 2019-12-06 | N |
| Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | Health | 2019-11-07 | 2019-12-06 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2019-11-07 | 2019-12-06 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2019-11-07 | 2019-12-06 | N |
| Observe each nurse aide's job performance and give regular training. | Health | 2019-11-07 | 2019-12-06 | 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 | 2019-11-07 | 2019-12-06 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2019-11-07 | 2019-12-06 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2019-08-08 | 2019-09-05 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2019-08-08 | 2019-09-05 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2019-08-08 | 2019-09-05 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2019-08-08 | 2019-09-05 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2019-08-08 | 2019-09-05 | N |
