A list of the most recent deficiencies for Complete Care at Corsica Hills 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 residents are fully informed and understand their health status, care and treatments. | Health | 2021-09-29 | 2021-10-28 | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2021-09-29 | 2021-10-28 | Y |
| Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. | Health | 2021-04-09 | 2021-05-14 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2021-04-09 | 2021-05-14 | Y |
| Plan the resident's discharge to meet the resident's goals and needs. | Health | 2021-04-09 | 2021-05-14 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2021-04-09 | 2021-05-14 | Y |
| Provide properly protected cooking facilities. | Fire Safety | 2019-05-23 | 2019-08-15 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2019-05-24 | 2019-07-08 | N |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2019-05-24 | 2019-07-08 | N |
| Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | Health | 2019-05-24 | 2019-07-08 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2019-05-24 | 2019-07-08 | 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 | 2019-05-24 | 2019-07-08 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2019-05-24 | 2019-07-08 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2019-05-24 | 2019-07-08 | N |
| Observe each nurse aide's job performance and give regular training. | Health | 2019-05-24 | 2019-07-08 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2019-05-24 | 2019-07-08 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2019-05-24 | 2019-07-08 | N |
| Dispose of garbage and refuse properly. | Health | 2019-05-24 | 2019-07-08 | N |
| Put firmly secured handrails on each side of hallways. | Health | 2019-05-24 | 2019-07-08 | N |
| Meet other general requirements. | Fire Safety | 2019-05-23 | 2019-07-03 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2019-05-23 | 2019-07-03 | N |
| Meet requirements for operating features, such as evacuation plans, fire drills, smoking regulations, draperies, decorations and the inspection, testing and maintenance of fire doors. | Fire Safety | 2019-05-23 | 2019-07-03 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2019-05-23 | 2019-07-03 | N |
| Meet requirements for the use of electrical equipment. | Fire Safety | 2019-05-23 | 2019-07-03 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2019-05-23 | 2019-06-27 | N |
| Meet other general requirements that are deficient. | Fire Safety | 2019-05-23 | 2019-06-19 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2019-05-23 | 2019-06-18 | N |
| Have exits that are accessible at all times. | Fire Safety | 2018-01-30 | 2018-04-30 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2018-01-30 | 2018-04-30 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2018-01-19 | 2018-02-28 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2018-01-19 | 2018-02-28 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2018-01-19 | 2018-02-28 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2018-01-19 | 2018-02-28 | 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 | 2018-01-19 | 2018-02-28 | N |
| Provide special eating equipment and utensils for residents who need them and appropriate assistance. | Health | 2018-01-19 | 2018-02-28 | 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 | 2017-01-20 | 2017-03-03 | N |
| Provide activities to meet the interests and needs of each resident. | Health | 2017-01-20 | 2017-03-03 | N |
| Ensure each resident receives an accurate assessment by a qualified health professional. | Health | 2017-01-20 | 2017-03-03 | N |
| Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2017-01-20 | 2017-03-03 | N |
| Allow residents the right to participate in the planning or revision of care and treatment. | Health | 2017-01-20 | 2017-03-03 | N |
| Provide care by qualified persons according to each resident's written plan of care. | Health | 2017-01-20 | 2017-03-03 | N |
| Provide necessary care and services to maintain or improve the highest well being of each resident . | Health | 2017-01-20 | 2017-03-03 | N |
| Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. | Health | 2017-01-20 | 2017-03-03 | N |
| Post nurse staffing information/data on a daily basis. | Health | 2017-01-20 | 2017-03-03 | N |
| At least once a month, have a licensed pharmacist review each resident's medication(s) and report any irregularities to the attending doctor. | Health | 2017-01-20 | 2017-03-03 | N |
| Maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards. | Health | 2017-01-20 | 2017-03-03 | N |
| Have a program that investigates, controls and keeps infection from spreading. | Health | 2017-01-20 | 2017-03-03 | N |
| Keep accurate, complete and organized clinical records on each resident that meet professional standards. | Health | 2017-01-20 | 2017-03-03 | N |
| Set up an ongoing quality assessment and assurance group to review quality deficiencies quarterly, and develop corrective plans of action. | Health | 2017-01-20 | 2017-03-03 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2017-01-23 | 2017-02-23 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2017-01-23 | 2017-02-23 | N |
