Deficiency Records for Optalis Health and Rehabilitation of Troy
Updated as of April 01, 2024
A list of the most recent deficiencies for Optalis Health and Rehabilitation of Troy. 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? |
|---|---|---|---|---|
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2023-10-26 | 2023-11-15 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-10-26 | 2023-11-15 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-10-26 | 2023-11-15 | 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 | 2023-10-26 | 2023-11-15 | 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 | 2023-10-26 | 2023-11-15 | N |
| Ensure each resident must receive and the facility must provide necessary behavioral health care and services. | Health | 2023-10-26 | 2023-11-15 | N |
| Provide medically-related social services to help each resident achieve the highest possible quality of life. | Health | 2023-10-26 | 2023-11-15 | 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 | 2023-10-26 | 2023-11-15 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-10-26 | 2023-11-15 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-10-26 | 2023-11-15 | Y |
| Conduct testing and exercise requirements. | Fire Safety | 2023-10-26 | 2023-11-15 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2023-10-26 | 2023-11-15 | 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 | 2023-10-26 | 2023-11-15 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2023-10-26 | 2023-11-15 | N |
| Construct fire resistant interior walls. | Fire Safety | 2023-10-26 | 2023-11-15 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2023-10-26 | 2023-11-15 | N |
| Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke. | Fire Safety | 2023-10-26 | 2023-11-15 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2023-10-26 | 2023-11-15 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2023-10-26 | 2023-11-15 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2023-10-26 | 2023-11-15 | N |
| Have power receptacles that are properly grounded. | Fire Safety | 2023-10-26 | 2023-11-15 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-10-26 | 2023-11-15 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2023-10-26 | 2023-11-15 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2023-09-28 | 2023-10-20 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-09-28 | 2023-10-20 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2023-09-28 | 2023-10-20 | Y |
| Plan the resident's discharge to meet the resident's goals and needs. | Health | 2023-02-24 | 2023-03-22 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-02-24 | 2023-03-22 | Y |
| Provide safe, appropriate pain management for a resident who requires such services. | Health | 2023-02-24 | 2023-03-22 | Y |
| Provide and implement an infection prevention and control program. | Health | 2022-11-17 | 2023-02-09 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-11-17 | 2023-02-01 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-01-12 | 2023-01-13 | Y |
| Implement emergency and standby power systems. | Fire Safety | 2022-11-18 | 2023-01-09 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2022-11-18 | 2023-01-09 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2022-11-18 | 2023-01-09 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2022-11-18 | 2023-01-09 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2022-11-17 | 2022-12-27 | N |
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2022-11-17 | 2022-12-27 | N |
| Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. | Health | 2022-11-17 | 2022-12-27 | N |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2022-11-17 | 2022-12-27 | N |
| Respond appropriately to all alleged violations. | Health | 2022-11-17 | 2022-12-27 | N |
| PASARR screening for Mental disorders or Intellectual Disabilities | Health | 2022-11-17 | 2022-12-27 | N |
| Provide medically-related social services to help each resident achieve the highest possible quality of life. | Health | 2022-11-17 | 2022-12-27 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2022-11-17 | 2022-12-27 | 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 | 2022-11-17 | 2022-12-27 | 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 | 2022-11-17 | 2022-12-27 | N |
| Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. | Health | 2022-11-17 | 2022-12-27 | N |
| Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. | Health | 2022-11-17 | 2022-12-27 | Y |
| Provide doctor's orders for the resident's immediate care at the time the resident was admitted. | Health | 2022-11-17 | 2022-12-27 | Y |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2022-11-17 | 2022-12-27 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-11-17 | 2022-12-27 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-11-17 | 2022-12-27 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2022-11-17 | 2022-12-27 | Y |
| Provide enough food/fluids to maintain a resident's health. | Health | 2022-11-17 | 2022-12-27 | Y |
| Provide for the safe, appropriate administration of IV fluids for a resident when needed. | Health | 2022-11-17 | 2022-12-27 | Y |
| Implement a program that monitors antibiotic use. | Health | 2022-11-17 | 2022-12-27 | Y |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2022-11-17 | 2022-12-27 | Y |
| 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 | 2022-11-17 | 2022-12-27 | Y |
| Ensure staff are vaccinated for COVID-19 | Health | 2022-11-17 | 2022-12-27 | Y |
| Address subsistence needs for staff and patients. | Fire Safety | 2022-11-18 | 2022-12-21 | N |
| Conduct testing and exercise requirements. | Fire Safety | 2022-11-18 | 2022-12-21 | 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 | 2022-11-18 | 2022-12-21 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2022-11-18 | 2022-12-21 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2022-11-18 | 2022-12-21 | N |
| Follow proper procedures when the fire alarm was out of service for more than 4 hours. | Fire Safety | 2022-11-18 | 2022-12-21 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-11-18 | 2022-12-21 | N |
| Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2022-11-18 | 2022-12-21 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2022-11-18 | 2022-12-21 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2022-11-18 | 2022-12-21 | N |
| Have elevators that firefighters can control in the event of a fire. | Fire Safety | 2022-11-18 | 2022-12-21 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2022-11-18 | 2022-12-21 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2022-07-26 | 2022-08-30 | Y |
| Respond appropriately to all alleged violations. | Health | 2022-07-26 | 2022-08-30 | Y |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2022-07-26 | 2022-08-30 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-07-26 | 2022-08-30 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-07-26 | 2022-08-30 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-04-20 | 2022-05-24 | 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 | 2022-04-20 | 2022-05-24 | Y |
| 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 | 2022-03-03 | 2022-03-28 | Y |
| Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident?s advance directives. | Health | 2022-01-20 | 2022-02-17 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-01-20 | 2022-02-17 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2021-12-02 | 2021-12-28 | Y |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2021-12-02 | 2021-12-28 | Y |
| Ensure that residents are free from significant medication errors. | Health | 2021-12-02 | 2021-12-28 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2021-08-05 | 2021-09-08 | N |
| Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. | Health | 2021-08-05 | 2021-09-08 | 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 | 2021-08-05 | 2021-09-08 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2021-08-05 | 2021-09-08 | N |
| Respond appropriately to all alleged violations. | Health | 2021-08-05 | 2021-09-08 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2021-08-05 | 2021-09-08 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2021-08-05 | 2021-09-08 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2021-08-05 | 2021-09-08 | 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 | 2021-08-05 | 2021-09-08 | 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 | 2021-08-05 | 2021-09-08 | N |
| Ensure that residents are free from significant medication errors. | Health | 2021-08-05 | 2021-09-08 | 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 | 2021-08-05 | 2021-09-08 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2021-08-05 | 2021-09-08 | N |
| List the names and contact information of those in the facility. | Fire Safety | 2021-08-05 | 2021-09-08 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2021-08-05 | 2021-09-08 | N |
| Have properly located and lighted "Exit" signs. | Fire Safety | 2021-08-05 | 2021-09-08 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2021-08-05 | 2021-09-08 | N |
| Install a fire alarm system that can be heard throughout the facility. | Fire Safety | 2021-08-05 | 2021-09-08 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2021-08-05 | 2021-09-08 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2021-08-05 | 2021-09-08 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2021-08-05 | 2021-09-08 | N |
| Have elevators that firefighters can control in the event of a fire. | Fire Safety | 2021-08-05 | 2021-09-08 | N |
| Provide a written emergency evacuation plan. | Fire Safety | 2021-08-05 | 2021-09-08 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2021-08-05 | 2021-09-08 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2021-08-05 | 2021-09-08 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2021-08-05 | 2021-09-08 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-07-08 | 2021-08-06 | Y |
| Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. | Health | 2021-04-29 | 2021-06-04 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2021-04-29 | 2021-06-04 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2021-04-29 | 2021-06-04 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2021-04-29 | 2021-06-04 | Y |
| Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. | Health | 2021-04-29 | 2021-06-04 | Y |
