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Deficiency Records for Mary, Queen and Mother Center
View the most recent health deficiencies and inspection results for Mary, Queen and Mother Center. Stay informed about quality of care issues.
View the most recent health deficiencies and inspection results for Mary, Queen and Mother Center. Stay informed about quality of care issues.
| Deficiency | Type of Deficiency | Deficiency Date | Date Corrected | Resulted from a Complaint? |
|---|---|---|---|---|
| Make sure that a working call system is available in each resident's bathroom and bathing area. | Health | 2025-12-19 | 2026-03-06 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2025-11-04 | 2025-12-19 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2025-11-04 | 2025-12-19 | Y |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2025-03-24 | 2025-05-05 | N |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2025-03-24 | 2025-05-05 | 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 | 2025-03-24 | 2025-05-05 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2025-03-24 | 2025-04-25 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2025-03-24 | 2025-04-25 | 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 | 2025-03-24 | 2025-04-25 | N |
| Ensure that residents are free from significant medication errors. | Health | 2025-03-24 | 2025-04-25 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2025-03-24 | 2025-04-25 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2025-03-24 | 2025-04-25 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2025-03-24 | 2025-04-25 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2024-01-08 | 2024-02-23 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2024-01-08 | 2024-02-23 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2024-01-08 | 2024-02-23 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2024-01-08 | 2024-02-23 | N |
| Observe each nurse aide's job performance and give regular training. | Health | 2024-01-08 | 2024-02-23 | N |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2024-01-08 | 2024-02-23 | N |
| Provide and implement an infection prevention and control program. | Health | 2024-01-08 | 2024-02-23 | N |
| Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2024-01-08 | 2024-02-23 | N |
| Conduct risk assessment and an All-Hazards approach. | Fire Safety | 2024-01-08 | 2024-02-23 | N |
| Establish staff and initial training requirements. | Fire Safety | 2024-01-08 | 2024-02-23 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2024-01-08 | 2024-02-23 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2024-01-08 | 2024-02-23 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2024-01-08 | 2024-02-23 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2024-01-08 | 2024-02-23 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2024-01-08 | 2024-02-23 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2024-01-08 | 2024-02-23 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2024-01-08 | 2024-02-23 | 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 | 2024-01-08 | 2023-10-01 | N |
| Post nurse staffing information every day. | Health | 2021-10-18 | 2021-12-03 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2021-10-18 | 2021-12-03 | N |
| Observe each nurse aide's job performance and give regular training. | Health | 2021-10-18 | 2021-12-03 | 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 | 2021-10-18 | 2021-12-03 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-10-18 | 2021-12-03 | 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 | 2021-10-18 | 2021-12-03 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2021-10-18 | 2021-12-03 | N |
| Assure the security of all personal funds of residents deposited with the facility. | Health | 2021-10-18 | 2021-12-03 | 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 | 2021-10-18 | 2021-12-03 | 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 | 2021-10-18 | 2021-12-03 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2021-10-18 | 2021-12-03 | 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 | 2021-10-18 | 2021-12-03 | N |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2021-10-18 | 2021-12-03 | N |
| Ensure each resident receives and the facility provides drinks consistent with resident needs and preferences and sufficient to maintain resident hydration. | Health | 2021-10-18 | 2021-12-03 | N |
| Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. | Health | 2021-10-18 | 2021-12-03 | N |
| Provide and implement an infection prevention and control program. | Health | 2021-10-18 | 2021-12-03 | N |
| Ensure each resident receives an accurate assessment. | Health | 2021-10-18 | 2021-12-03 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2021-10-18 | 2021-12-03 | N |
| Not require residents to give up Medicare or Medicaid benefits, or pay privately as a condition of admission; and must tell residents what care they do not provide. | Health | 2021-10-18 | 2021-12-03 | N |
| Respond appropriately to all alleged violations. | Health | 2021-10-18 | 2021-12-03 | N |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2021-10-18 | 2021-12-03 | N |
| Allow residents to easily view the nursing home's survey results and communicate with advocate agencies. | Health | 2021-10-18 | 2021-12-03 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2021-10-18 | 2021-12-03 | N |
| Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home. | Health | 2021-10-18 | 2021-12-03 | N |
| Honor the resident's right to manage his or her financial affairs. | Health | 2021-10-18 | 2021-12-03 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2021-10-18 | 2021-12-03 | 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 | 2021-10-18 | 2021-12-03 | 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 | 2021-10-18 | 2021-12-03 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2021-10-18 | 2021-12-03 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2021-10-18 | 2021-12-03 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2021-10-18 | 2021-12-03 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2021-10-18 | 2021-12-03 | N |