Deficiency Records for Lutheran Senior Services at Breeze Park
Updated as of October 01, 2020
This is not the most recent data for Lutheran Senior Services at Breeze Park. For the most recent information, click here.
A list of the most recent deficiencies for Lutheran Senior Services at Breeze Park. 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? |
---|---|---|---|---|
Install proper backup exit lighting. | Fire Safety | 2019-10-11 | 2019-11-22 | N |
Have properly located and lighted "Exit" signs. | Fire Safety | 2019-10-11 | 2019-11-22 | N |
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2019-10-11 | 2019-11-22 | N |
Have restrictions on the use of highly flammable decorations. | Fire Safety | 2019-10-11 | 2019-11-22 | N |
Have restrictions on the use of portable space heaters. | Fire Safety | 2019-10-11 | 2019-11-22 | N |
Ensure proper usage of power strips and extension cords. | Fire Safety | 2019-10-11 | 2019-11-22 | N |
Assess the resident when there is a significant change in condition | Health | 2019-10-11 | 2019-11-22 | N |
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2019-10-11 | 2019-11-22 | N |
Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. | Health | 2019-10-11 | 2019-11-22 | 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 | 2019-10-11 | 2019-11-22 | 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 | 2019-10-11 | 2019-11-22 | N |
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2019-10-11 | 2019-10-11 | Y |
Implement emergency and standby power systems. | Fire Safety | 2018-08-23 | 2018-10-05 | N |
Use approved construction type or materials. | Fire Safety | 2018-08-23 | 2018-10-05 | N |
Install corridor and hallway doors that block smoke. | Fire Safety | 2018-08-23 | 2018-10-05 | N |
Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2018-08-23 | 2018-10-05 | N |
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 | 2018-08-23 | 2018-10-05 | N |
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | Health | 2018-08-23 | 2018-10-05 | N |
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2018-08-23 | 2018-10-05 | N |
Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2018-08-23 | 2018-10-05 | N |
Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2017-11-03 | 2017-11-30 | N |
Install corridor and hallway doors that block smoke. | Fire Safety | 2017-11-03 | 2017-11-30 | N |
Have simulated fire drills held at unexpected times. | Fire Safety | 2017-11-03 | 2017-11-30 | N |
Have proper medical gas storage and administration areas. | Fire Safety | 2017-11-03 | 2017-11-30 | N |
Meet other general requirements. | Fire Safety | 2017-11-03 | 2017-11-30 | N |
Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. | Health | 2017-10-26 | 2017-11-30 | Y |
Provide housekeeping and maintenance services. | Health | 2017-11-03 | 2017-11-30 | N |
Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. | Health | 2017-11-03 | 2017-11-30 | N |
Store, cook, and serve food in a safe and clean way. | Health | 2017-11-03 | 2017-11-30 | N |