A list of the most recent deficiencies for Samaritan Bethany Home On Eighth. 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? |
|---|---|---|---|---|
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2023-05-11 | 2023-06-16 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2023-05-11 | 2023-06-16 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-05-11 | 2023-04-27 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-12-20 | 2023-02-03 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2022-12-02 | 2023-01-06 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-12-02 | 2023-01-06 | Y |
| 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 | 2022-10-28 | 2022-12-09 | N |
| Provide activities to meet all resident's needs. | Health | 2022-10-28 | 2022-12-09 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2022-10-27 | 2022-12-09 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-10-27 | 2022-12-09 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2022-10-27 | 2022-12-09 | N |
| Have restrictions on the use of highly flammable decorations. | Fire Safety | 2022-10-27 | 2022-12-09 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2022-10-27 | 2022-12-09 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2022-10-27 | 2022-12-09 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2022-10-27 | 2022-12-09 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2022-10-27 | 2022-12-09 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2022-01-27 | 2022-02-25 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-01-27 | 2022-02-11 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2021-04-20 | 2021-06-04 | 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 | 2021-04-20 | 2021-06-04 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2021-04-20 | 2021-06-04 | Y |
| Observe each nurse aide's job performance and give regular training. | Health | 2019-04-15 | 2019-07-17 | 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 | 2019-04-15 | 2019-07-17 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2019-04-15 | 2019-05-30 | N |
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2019-04-15 | 2019-05-30 | 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 | 2019-04-15 | 2019-05-30 | N |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2019-04-15 | 2019-05-30 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2019-04-15 | 2019-05-30 | N |
| Respond appropriately to all alleged violations. | Health | 2019-04-15 | 2019-05-30 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2019-04-15 | 2019-05-30 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2019-04-15 | 2019-05-30 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2019-04-15 | 2019-05-30 | 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 | 2019-04-15 | 2019-05-30 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2019-04-15 | 2019-05-30 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2019-04-15 | 2019-05-30 | N |
| Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. | Health | 2019-04-15 | 2019-05-30 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2019-04-15 | 2019-05-30 | N |
| Provide and implement an infection prevention and control program. | Health | 2019-04-15 | 2019-05-30 | N |
| Implement a program that monitors antibiotic use. | Health | 2019-04-15 | 2019-05-30 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2019-04-15 | 2019-05-30 | N |
| Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation. | Health | 2019-04-15 | 2019-05-30 | N |
| Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk. | Fire Safety | 2019-04-09 | 2019-05-24 | N |
| Have proper fire barriers, ventilation and signs for the transfilling of oxygen. | Fire Safety | 2019-04-09 | 2019-05-24 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2018-03-16 | 2018-06-08 | N |
| Provide or get specialized rehabilitative services as required for a resident. | Health | 2018-03-16 | 2018-06-08 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2018-03-13 | 2018-05-04 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2018-03-13 | 2018-05-04 | N |
| Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. | Health | 2018-03-16 | 2018-04-25 | N |
| Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | Health | 2018-03-16 | 2018-04-25 | 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 | 2018-03-16 | 2018-04-25 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2018-03-16 | 2018-04-25 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2018-03-16 | 2018-04-25 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2018-03-16 | 2018-04-25 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2018-03-16 | 2018-04-25 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2018-03-16 | 2018-04-25 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2018-03-16 | 2018-04-25 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2018-03-16 | 2018-04-25 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2018-03-16 | 2018-04-25 | N |
| Ensure each resident receives and the facility provides drinks consistent with resident needs and preferences and sufficient to maintain resident hydration. | Health | 2018-03-16 | 2018-04-25 | N |
| Provide and implement an infection prevention and control program. | Health | 2018-03-16 | 2018-04-25 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2018-03-16 | 2018-04-25 | N |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2018-03-16 | 2018-04-25 | N |
