Deficiency Records for Sixteen Acres Healthcare Center
Updated as of July 01, 2018
This is not the most recent data for Sixteen Acres Healthcare Center. For the most recent information, click here.
A list of the most recent deficiencies for Sixteen Acres Healthcare 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? |
---|---|---|---|---|
Provide properly protected cooking facilities. | Fire Safety | 2018-02-20 | 2018-03-23 | N |
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. | Health | 2018-01-31 | 2018-03-15 | N |
Ensure each resident receives an accurate assessment. | Health | 2018-01-31 | 2018-03-15 | N |
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2018-01-31 | 2018-03-15 | N |
Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2018-01-31 | 2018-03-15 | N |
Assist a resident in gaining access to vision and hearing services. | Health | 2018-01-31 | 2018-03-15 | N |
Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2018-01-31 | 2018-03-15 | 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 | 2018-01-31 | 2018-03-15 | N |
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2018-01-31 | 2018-03-15 | N |
Implement a program that monitors antibiotic use. | Health | 2018-01-31 | 2018-03-15 | N |
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2018-01-31 | 2018-03-15 | Y |
Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2018-01-31 | 2018-03-15 | Y |
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2018-01-31 | 2018-03-15 | Y |
Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2018-02-20 | 2018-03-09 | N |
Establish emergency prep training and testing. | Fire Safety | 2018-02-20 | 2018-03-01 | N |
Have simulated fire drills held at unexpected times. | Fire Safety | 2018-02-20 | 2018-03-01 | N |
Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2018-02-20 | 2018-03-01 | N |
Let residents refuse treatment, refuse to take part in an experiment, or formulate advance directives. | Health | 2017-04-19 | 2017-05-30 | Y |
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2017-04-19 | 2017-05-30 | Y |
Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2017-04-19 | 2017-05-30 | Y |
Provide necessary care and services to maintain or improve the highest well being of each resident . | Health | 2017-04-19 | 2017-05-30 | Y |
Keep all essential equipment working safely. | Health | 2017-04-19 | 2017-05-30 | Y |
Keep accurate, complete and organized clinical records on each resident that meet professional standards. | Health | 2017-04-19 | 2017-05-30 | Y |
Set up an ongoing quality assessment and assurance group to review quality deficiencies quarterly, and develop corrective plans of action. | Health | 2017-04-19 | 2017-05-30 | Y |
Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2016-12-05 | 2016-12-19 | 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 | 2016-11-08 | 2016-12-16 | N |
Ensure each resident receives an accurate assessment by a qualified health professional. | Health | 2016-11-08 | 2016-12-16 | N |
Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2016-11-08 | 2016-12-16 | N |
Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2016-11-08 | 2016-12-16 | N |
Provide care by qualified persons according to each resident's written plan of care. | Health | 2016-11-08 | 2016-12-16 | N |
Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature. | Health | 2016-11-08 | 2016-12-16 | N |
Store, cook, and serve food in a safe and clean way. | Health | 2016-11-08 | 2016-12-16 | N |
Maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards. | Health | 2016-11-08 | 2016-12-16 | N |
Have a program that investigates, controls and keeps infection from spreading. | Health | 2016-11-08 | 2016-12-16 | N |
1) Receive registry verification that a nurse aide has met the required training and skills that the State requires; and 2) ensure nurse aides receive the required retraining after 24 months if nursing related services were not provided for monetary compe | Health | 2016-11-08 | 2016-12-16 | N |
Keep accurate, complete and organized clinical records on each resident that meet professional standards. | Health | 2016-11-08 | 2016-12-16 | N |
Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. | Health | 2016-02-18 | 2016-03-31 | Y |
Let residents refuse treatment, refuse to take part in an experiment, or formulate advance directives. | Health | 2015-08-17 | 2015-09-30 | N |
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2015-08-17 | 2015-09-30 | N |
Provide residents with private access to a telephone. | Health | 2015-08-17 | 2015-09-30 | N |
Keep each resident free from physical restraints, unless needed for medical treatment. | Health | 2015-08-17 | 2015-09-30 | N |
Provide housekeeping and maintenance services. | Health | 2015-08-17 | 2015-09-30 | N |
Ensure each resident receives an accurate assessment by a qualified health professional. | Health | 2015-08-17 | 2015-09-30 | N |
Provide care by qualified persons according to each resident's written plan of care. | Health | 2015-08-17 | 2015-09-30 | N |
Make sure that each residents' abilities in activities of daily living do not decline, unless unavoidable. | Health | 2015-08-17 | 2015-09-30 | N |
Assist those residents who need help with eating/drinking, grooming and personal and oral hygiene. | Health | 2015-08-17 | 2015-09-30 | N |
Ensure that residents receive proper treatment and assistive devices to maintain their vision and hearing. | Health | 2015-08-17 | 2015-09-30 | N |
Ensure that each resident who enters the nursing home without a catheter is not given a catheter, unless medically necessary, and that incontinent patients receive proper services to prevent urinary tract infections and restore normal bladder functions. | Health | 2015-08-17 | 2015-09-30 | N |
Give the right treatment and services to residents who display physical or psychosocial problems adapting to changes in circumstances. | Health | 2015-08-17 | 2015-09-30 | 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 | 2015-08-17 | 2015-09-30 | N |
Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature. | Health | 2015-08-17 | 2015-09-30 | N |
Make sure that all required doctor visits are made personally. | Health | 2015-08-17 | 2015-09-30 | N |
Give or get specialized rehabilitative services per the patient's assessment or plan of care. | Health | 2015-08-17 | 2015-09-30 | N |
Provide or obtain dental services for each resident. | Health | 2015-08-17 | 2015-09-30 | N |
Keep accurate, complete and organized clinical records on each resident that meet professional standards. | Health | 2015-08-17 | 2015-09-30 | N |
Walls that prevent smoke from passing through and would resist fire for at least one hour. | Fire Safety | 2015-08-19 | 2015-09-26 | N |
Exits that are free from obstructions and can be used at all times. | Fire Safety | 2015-08-19 | 2015-09-26 | N |