Deficiency Records for Regency Manor Nursing and Rehabilitation Center
Updated as of October 01, 2021
This is not the most recent data for Regency Manor Nursing and Rehabilitation Center. For the most recent information, click here.
A list of the most recent deficiencies for Regency Manor Nursing and Rehabilitation 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 an approved automatic sprinkler system. | Fire Safety | 2021-02-17 | 2021-05-18 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2021-02-17 | 2021-05-18 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2021-02-17 | 2021-03-19 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2021-02-17 | 2021-03-19 | N |
| Have restrictions on the use of portable space heaters. | Fire Safety | 2021-02-17 | 2021-03-19 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2021-02-18 | 2021-03-12 | 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 | 2021-02-18 | 2021-03-12 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2021-02-18 | 2021-03-12 | 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 | 2021-02-18 | 2021-03-12 | 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 | 2021-02-18 | 2021-03-12 | 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 | 2021-02-18 | 2021-03-12 | Y |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2021-02-17 | 2021-02-19 | N |
| Have exits that are accessible at all times. | Fire Safety | 2019-11-14 | 2020-04-01 | 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 | 2019-11-14 | 2019-12-20 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2019-11-14 | 2019-12-20 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2019-11-14 | 2019-12-20 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2019-11-14 | 2019-12-20 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2019-11-14 | 2019-12-20 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2019-11-14 | 2019-12-20 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2019-11-14 | 2019-12-20 | 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 | 2019-11-13 | 2019-12-16 | Y |
| Notify the resident or the resident?s representative in writing how long the nursing home will hold the resident?s bed in cases of transfer to a hospital or therapeutic leave. | Health | 2019-11-13 | 2019-12-16 | N |
| PASARR screening for Mental disorders or Intellectual Disabilities | Health | 2019-11-13 | 2019-12-16 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2019-11-13 | 2019-12-16 | N |
| Provide activities to meet all resident's needs. | Health | 2019-11-13 | 2019-12-16 | 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 | 2019-11-13 | 2019-12-16 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2019-11-13 | 2019-12-16 | N |
| Provide and implement an infection prevention and control program. | Health | 2019-11-13 | 2019-12-16 | N |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2019-10-07 | 2019-10-21 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2019-07-30 | 2019-08-30 | 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 | 2019-07-30 | 2019-08-30 | Y |
| 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 | 2019-01-10 | 2019-04-03 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2019-01-10 | 2019-04-03 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2019-01-10 | 2019-04-03 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2019-01-10 | 2019-04-03 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2019-01-10 | 2019-04-03 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2019-01-10 | 2019-03-08 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2019-01-10 | 2019-03-08 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2019-01-10 | 2019-03-08 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2019-01-10 | 2019-03-08 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2019-01-10 | 2019-03-08 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2019-01-10 | 2019-03-08 | 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 | 2019-01-08 | 2019-02-04 | N |
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2019-01-08 | 2019-02-04 | 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 | 2019-01-08 | 2019-02-04 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2019-01-08 | 2019-02-04 | N |
| 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 | 2019-01-08 | 2019-02-04 | 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 | 2019-01-08 | 2019-02-04 | 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 | 2019-01-08 | 2019-02-04 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2019-01-08 | 2019-02-04 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2018-12-07 | 2018-12-28 | Y |
