A list of the most recent deficiencies for Imperial, A Villa 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? |
|---|---|---|---|---|
| Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | Health | 2023-12-13 | 2024-01-14 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2023-12-13 | 2024-01-14 | 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 | 2023-12-13 | 2024-01-14 | 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 | 2023-12-13 | 2024-01-14 | 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 | 2023-12-13 | 2024-01-14 | N |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2023-12-13 | 2024-01-14 | 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 | 2023-12-13 | 2024-01-14 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-12-13 | 2024-01-14 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-12-13 | 2024-01-14 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-12-13 | 2024-01-14 | Y |
| Provide and implement an infection prevention and control program. | Health | 2023-12-13 | 2024-01-14 | Y |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2023-12-13 | 2024-01-14 | Y |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2023-12-12 | 2024-01-14 | 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 | 2023-12-12 | 2024-01-14 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-12-12 | 2024-01-14 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2023-08-30 | 2023-09-22 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-08-30 | 2023-09-22 | Y |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2023-08-30 | 2023-09-22 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-06-07 | 2023-06-20 | Y |
| Allow residents to easily view the nursing home's survey results and communicate with advocate agencies. | Health | 2022-09-29 | 2022-11-08 | N |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2022-09-29 | 2022-11-08 | Y |
| 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 | 2022-09-29 | 2022-11-08 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2022-09-29 | 2022-11-08 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-09-29 | 2022-11-08 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-09-29 | 2022-11-08 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2022-09-29 | 2022-11-08 | 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 | 2022-09-29 | 2022-11-08 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-09-29 | 2022-11-08 | Y |
| Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. | Health | 2022-09-29 | 2022-11-08 | Y |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2022-09-29 | 2022-11-08 | Y |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2022-10-04 | 2022-10-31 | 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 | 2022-10-04 | 2022-10-31 | N |
| Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector. | Fire Safety | 2022-10-04 | 2022-10-31 | N |
| Provide sliding doors free of hazards, operable without special knowledge or effort, and meet weight requirements to set door in motion. | Fire Safety | 2022-10-04 | 2022-10-31 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-10-04 | 2022-10-31 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2022-10-04 | 2022-10-31 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2022-10-04 | 2022-10-31 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2022-10-04 | 2022-10-31 | N |
| Have power receptacles that are properly grounded. | Fire Safety | 2022-10-04 | 2022-10-31 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2022-10-04 | 2022-10-31 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-07-27 | 2022-08-15 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2022-07-27 | 2022-08-15 | Y |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2022-07-27 | 2022-08-15 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-05-26 | 2022-06-16 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-05-26 | 2022-06-16 | 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 | 2022-05-26 | 2022-06-16 | Y |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-05-26 | 2022-06-16 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2021-11-29 | 2022-02-11 | Y |
| Provide and implement an infection prevention and control program. | Health | 2021-11-29 | 2022-02-11 | Y |
| Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy. | Health | 2021-11-29 | 2021-12-22 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2021-11-29 | 2021-12-22 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2021-11-29 | 2021-12-22 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2021-11-29 | 2021-12-22 | 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 | 2021-11-29 | 2021-12-22 | Y |
| Provide enough food/fluids to maintain a resident's health. | Health | 2021-11-29 | 2021-12-22 | Y |
| Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit. | Health | 2021-11-29 | 2021-12-22 | Y |
| Implement a program that monitors antibiotic use. | Health | 2021-11-29 | 2021-12-22 | 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 | 2021-06-09 | 2021-07-30 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-06-09 | 2021-07-13 | Y |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2021-06-09 | 2021-07-13 | Y |
| Provide and implement an infection prevention and control program. | Health | 2021-06-09 | 2021-07-13 | Y |
| Make sure that a working call system is available in each resident's bathroom and bathing area. | Health | 2021-06-09 | 2021-07-13 | Y |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2021-06-09 | 2021-07-13 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2021-06-09 | 2021-07-13 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2021-06-09 | 2021-07-13 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2021-06-09 | 2021-07-13 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2021-06-09 | 2021-07-13 | N |
| Ensure meals and snacks are served at times in accordance with resident?s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. | Health | 2021-06-09 | 2021-07-13 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2021-06-09 | 2021-07-13 | Y |
| Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. | Health | 2021-06-09 | 2021-07-13 | Y |
| Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | Health | 2021-06-09 | 2021-07-13 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2021-06-09 | 2021-07-13 | 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 | 2021-06-09 | 2021-07-13 | Y |
| Ensure medication error rates are not 5 percent or greater. | Health | 2021-06-09 | 2021-07-13 | Y |
| Ensure that residents are free from significant medication errors. | Health | 2021-06-09 | 2021-07-13 | Y |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2021-06-09 | 2021-07-13 | Y |
| Install an approved automatic sprinkler system. | Fire Safety | 2021-06-10 | 2021-07-13 | N |
| Have restrictions on the use of portable space heaters. | Fire Safety | 2021-06-10 | 2021-07-13 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2021-06-10 | 2021-07-13 | N |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2021-04-27 | 2021-05-07 | Y |
