A list of the most recent deficiencies for Woodland 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? |
|---|---|---|---|---|
| Have exits that are accessible at all times. | Fire Safety | 2023-10-21 | 2024-04-21 | N |
| Install proper backup exit lighting. | Fire Safety | 2023-10-21 | 2023-12-13 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2023-10-20 | 2023-12-03 | 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 | 2023-10-20 | 2023-12-03 | N |
| Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. | Health | 2023-10-20 | 2023-12-03 | N |
| Assure that each resident?s assessment is updated at least once every 3 months. | Health | 2023-10-20 | 2023-12-03 | N |
| Assist a resident in gaining access to vision and hearing services. | Health | 2023-10-20 | 2023-12-03 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-10-20 | 2023-12-03 | 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 | 2023-10-21 | 2023-12-03 | N |
| Provide a written emergency evacuation plan. | Fire Safety | 2023-10-21 | 2023-12-03 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2023-10-21 | 2023-12-03 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-10-21 | 2023-12-03 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2023-10-21 | 2023-12-03 | N |
| Ensure that sources of ignition are removed from patients receiving respiratory therapy. | Fire Safety | 2023-10-21 | 2023-12-03 | N |
| Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk. | Fire Safety | 2023-10-21 | 2023-12-03 | N |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-08-25 | 2023-10-09 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2023-08-25 | 2023-10-09 | Y |
| Respond appropriately to all alleged violations. | Health | 2023-08-25 | 2023-10-09 | Y |
| Protect each resident from the wrongful use of the resident's belongings or money. | Health | 2023-06-14 | 2023-07-26 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2023-06-14 | 2023-07-26 | Y |
| Protect each resident from the wrongful use of the resident's belongings or money. | Health | 2023-04-27 | 2023-07-26 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2023-04-27 | 2023-07-26 | Y |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2023-04-27 | 2023-06-10 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2023-01-19 | 2023-03-01 | Y |
| Provide enough food/fluids to maintain a resident's health. | Health | 2023-01-19 | 2023-03-01 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2022-12-21 | 2023-01-13 | Y |
| Protect each resident from the wrongful use of the resident's belongings or money. | Health | 2022-11-21 | 2023-01-05 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2022-11-21 | 2023-01-05 | Y |
| Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | Health | 2021-08-19 | 2021-10-08 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2021-05-14 | 2021-06-23 | Y |
| Protect each resident from the wrongful use of the resident's belongings or money. | Health | 2021-05-14 | 2021-06-23 | Y |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2020-02-27 | 2020-04-10 | N |
| Notify the resident or the resident?s representative in writing how long the nursing home will hold the resident?s bed in cases of transfer to a hospital or therapeutic leave. | Health | 2020-02-27 | 2020-04-10 | 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 | 2020-02-27 | 2020-04-10 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2020-02-27 | 2020-04-10 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2020-02-27 | 2020-04-10 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2019-01-24 | 2019-03-09 | 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 | 2019-01-24 | 2019-03-09 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2019-01-24 | 2019-03-09 | N |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2019-01-24 | 2019-03-09 | N |
| Have a complete alarm system manually initiated and initiated by fire sprinkler system connection. | Fire Safety | 2019-01-24 | 2019-03-09 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2019-01-24 | 2019-02-22 | N |
| Have power receptacles that are properly grounded. | Fire Safety | 2019-01-24 | 2019-02-14 | N |
| Meet requirements for the use of electrical equipment. | Fire Safety | 2019-01-24 | 2019-02-14 | N |
| Properly provide smoke detection systems in areas open to corridors. | Fire Safety | 2019-01-24 | 2019-02-13 | N |
| Use approved construction type or materials. | Fire Safety | 2019-01-24 | 2019-02-04 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2019-01-24 | 2019-02-04 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2019-01-24 | 2019-01-31 | N |
