A list of the most recent deficiencies for Brookhaven Nursing and Rehab. 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? |
|---|---|---|---|---|
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-10-13 | 2023-11-21 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2023-10-13 | 2023-11-21 | Y |
| Respond appropriately to all alleged violations. | Health | 2023-10-13 | 2023-11-21 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2023-08-24 | 2023-10-08 | Y |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-06-08 | 2023-07-27 | N |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2023-06-08 | 2023-07-27 | N |
| Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | Health | 2023-06-08 | 2023-07-23 | N |
| Ensure that residents are free from significant medication errors. | Health | 2023-06-08 | 2023-07-23 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2023-06-08 | 2023-07-23 | Y |
| 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 | 2023-06-08 | 2023-07-23 | Y |
| Provide and implement an infection prevention and control program. | Health | 2023-06-08 | 2023-07-23 | Y |
| Use approved construction type or materials. | Fire Safety | 2023-06-08 | 2023-07-23 | 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 | 2023-06-08 | 2023-07-23 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-06-08 | 2023-07-23 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2023-06-08 | 2023-07-23 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2023-06-08 | 2023-07-23 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2023-06-08 | 2023-07-23 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-06-08 | 2023-07-23 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2023-06-08 | 2023-07-23 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2023-06-08 | 2023-06-08 | N |
| Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. | Health | 2022-03-02 | 2022-03-27 | Y |
| Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. | Health | 2021-12-29 | 2022-03-27 | Y |
| Provide and implement an infection prevention and control program. | Health | 2022-01-11 | 2022-02-25 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-12-29 | 2022-02-12 | Y |
| Protect each resident from the wrongful use of the resident's belongings or money. | Health | 2021-10-22 | 2021-12-06 | Y |
| Ensure residents have reasonable access to and privacy in their use of communication methods. | Health | 2021-09-27 | 2021-11-11 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2021-09-27 | 2021-11-11 | Y |
| Keep residents' personal and medical records private and confidential. | Health | 2020-01-31 | 2020-03-15 | N |
| Respond appropriately to all alleged violations. | Health | 2020-01-31 | 2020-03-15 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2020-01-31 | 2020-03-15 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2020-01-31 | 2020-03-15 | 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 | 2020-01-31 | 2020-03-15 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2020-01-31 | 2020-03-15 | N |
| Ensure that residents are free from significant medication errors. | Health | 2020-01-31 | 2020-03-15 | 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 | 2020-01-31 | 2020-03-15 | N |
| Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. | Health | 2020-01-31 | 2020-03-15 | N |
| Have enough outside ventilation via a window or mechanical ventilation, or both. | Health | 2020-01-31 | 2020-03-15 | 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 | 2020-01-31 | 2020-03-15 | N |
| Use approved construction type or materials. | Fire Safety | 2019-02-19 | 2019-04-05 | N |
