Deficiency Records for Helen Newberry Joy Hltcu Golden Leaves Living Ctr
Updated as of March 01, 2024
A list of the most recent deficiencies for Helen Newberry Joy Hltcu Golden Leaves Living Ctr. 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? |
|---|---|---|---|---|
| Conduct testing and exercise requirements. | Fire Safety | 2023-07-25 | 2023-09-24 | 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 | 2023-07-25 | 2023-09-24 | N |
| Follow proper procedures when the fire alarm was out of service for more than 4 hours. | Fire Safety | 2023-07-25 | 2023-09-10 | 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 | 2023-07-20 | 2023-08-25 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2023-07-20 | 2023-08-25 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-07-20 | 2023-08-25 | 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 | 2023-07-20 | 2023-08-25 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-07-20 | 2023-08-25 | Y |
| Provide care or services that was trauma informed and/or culturally competent. | Health | 2023-07-20 | 2023-08-25 | Y |
| Post nurse staffing information every day. | Health | 2023-07-20 | 2023-08-25 | Y |
| Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2023-07-25 | 2023-08-24 | N |
| Have a fire alarm with audible and visual signals that transmits the alarm automatically to notify emergency forces in event of fire. | Fire Safety | 2023-07-25 | 2023-08-15 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2023-07-25 | 2023-08-10 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2023-03-09 | 2023-04-17 | Y |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2022-06-08 | 2023-02-28 | N |
| Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | Health | 2022-06-09 | 2022-07-27 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2022-06-09 | 2022-07-12 | 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 | 2022-06-09 | 2022-07-12 | 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 | 2022-06-09 | 2022-07-12 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-06-09 | 2022-07-12 | N |
| Perform COVID19 testing on residents and staff. | Health | 2022-06-09 | 2022-07-12 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2022-06-09 | 2022-07-12 | Y |
| Ensure that residents are free from significant medication errors. | Health | 2022-06-09 | 2022-07-12 | Y |
| Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2022-06-08 | 2022-07-12 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2022-06-08 | 2022-07-12 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2022-06-08 | 2022-07-12 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2022-06-08 | 2022-07-12 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2022-06-08 | 2022-07-12 | N |
| Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | Health | 2021-04-27 | 2021-07-07 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2021-04-27 | 2021-07-07 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2021-04-27 | 2021-06-30 | Y |
| Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | Health | 2021-04-27 | 2021-05-27 | 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 | 2021-04-27 | 2021-05-27 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-04-27 | 2021-05-27 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2021-04-27 | 2021-05-27 | N |
| Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. | Health | 2021-04-27 | 2021-05-27 | N |
| Provide and implement an infection prevention and control program. | Health | 2021-04-27 | 2021-05-27 | N |
| Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. | Health | 2021-04-27 | 2021-05-27 | N |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2021-04-27 | 2021-05-27 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2021-04-27 | 2021-05-27 | Y |
| Respond appropriately to all alleged violations. | Health | 2021-04-27 | 2021-05-27 | Y |
| Assess the resident when there is a significant change in condition | Health | 2021-04-27 | 2021-05-27 | Y |
| Provide properly protected cooking facilities. | Fire Safety | 2021-04-22 | 2021-05-27 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2021-04-22 | 2021-05-27 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2021-04-22 | 2021-05-27 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2021-04-22 | 2021-05-27 | 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 | 2021-04-22 | 2021-04-29 | N |