A list of the most recent deficiencies for Hickory Manor. 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? |
|---|---|---|---|---|
| Ensure each resident receives an accurate assessment. | Health | 2024-01-11 | 2024-02-25 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2024-01-11 | 2024-02-25 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2024-01-11 | 2024-02-25 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2024-01-11 | 2024-02-25 | N |
| Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. | Health | 2024-01-11 | 2024-02-25 | N |
| Post nurse staffing information every day. | Health | 2024-01-11 | 2024-02-25 | 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 | 2024-01-11 | 2024-02-25 | 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 | 2024-01-11 | 2024-02-25 | N |
| Dispose of garbage and refuse properly. | Health | 2024-01-11 | 2024-02-25 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2024-01-11 | 2024-02-25 | N |
| 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 | 2024-01-11 | 2024-02-25 | N |
| Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. | Health | 2024-01-11 | 2024-02-25 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2024-01-11 | 2024-02-25 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2024-01-11 | 2024-02-25 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2023-10-30 | 2023-11-30 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-11-21 | 2023-01-05 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-03-03 | 2022-04-15 | N |
| Ensure that residents are free from significant medication errors. | Health | 2022-03-03 | 2022-04-15 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-03-03 | 2022-04-15 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-03-03 | 2022-04-15 | N |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2022-03-03 | 2022-04-15 | 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 | 2022-03-03 | 2022-04-15 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-03-03 | 2022-04-15 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2022-03-03 | 2022-04-15 | N |
| Provide safe, appropriate pain management for a resident who requires such services. | Health | 2021-03-03 | 2021-04-12 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2019-06-20 | 2019-08-04 | N |
| 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 | 2019-06-20 | 2019-08-04 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2019-06-20 | 2019-08-04 | 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 | 2019-06-20 | 2019-08-04 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2019-06-20 | 2019-08-04 | N |
| Ensure that residents are free from significant medication errors. | Health | 2019-06-20 | 2019-08-04 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2019-06-20 | 2019-08-04 | N |
| Provide and implement an infection prevention and control program. | Health | 2019-06-20 | 2019-08-04 | N |
| Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame. | Health | 2019-06-20 | 2019-08-04 | N |
