Deficiency Records for Southlake Village Rehabilitation and Care Center

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Updated as of February 01, 2023

This is not the most recent data for Southlake Village Rehabilitation and Care Center. For the most recent information, click here.

A list of the most recent deficiencies for Southlake Village Rehabilitation and Care Center. 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?
Provide and implement an infection prevention and control program. Health 2022-08-24 2022-09-26 Y
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Health 2022-05-12 2022-06-21 N
Ensure each resident receives an accurate assessment. Health 2022-05-12 2022-06-21 N
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2022-05-12 2022-06-21 N
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2022-05-12 2022-06-21 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 2022-05-12 2022-06-21 N
Provide safe and appropriate respiratory care for a resident when needed. Health 2022-05-12 2022-06-21 N
Provide safe, appropriate pain management for a resident who requires such services. Health 2022-05-12 2022-06-21 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 2022-05-12 2022-06-21 N
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Health 2022-05-12 2022-06-21 N
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2022-05-12 2022-06-21 N
Implement emergency and standby power systems. Fire Safety 2022-05-12 2022-06-21 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 2022-05-12 2022-06-21 N
Provide properly protected cooking facilities. Fire Safety 2022-05-12 2022-06-21 N
Inspect, test, and maintain automatic sprinkler systems. Fire Safety 2022-05-12 2022-06-21 N
Install corridor and hallway doors that block smoke. Fire Safety 2022-05-12 2022-06-21 N
Meet other general requirements that are deficient. Fire Safety 2022-05-12 2022-06-21 N
To conduct inspection, testing and maintenance of fire doors by qualified individuals. Fire Safety 2022-05-12 2022-06-21 N
Have generator or other power source capable of supplying service within 10 seconds. Fire Safety 2022-05-12 2022-06-21 N
Ensure that testing and maintenance of electrical equipment is performed. Fire Safety 2022-05-12 2022-06-21 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 2020-09-18 2020-10-22 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 2020-09-18 2020-10-22 N
Inspect, test, and maintain automatic sprinkler systems. Fire Safety 2020-09-18 2020-10-22 N
Have properly installed electrical wiring and gas equipment. Fire Safety 2020-09-18 2020-10-22 N
Provide and implement an infection prevention and control program. Health 2020-06-11 2020-07-27 N
Meet other general requirements that are deficient. Fire Safety 2019-03-26 2019-05-07 N
Install corridor and hallway doors that block smoke. Fire Safety 2019-03-26 2019-05-07 N
Have simulated fire drills held at unexpected times. Fire Safety 2019-03-26 2019-05-07 N
Have restrictions on the use of highly flammable decorations. Fire Safety 2019-03-26 2019-05-07 N
Ensure proper usage of power strips and extension cords. Fire Safety 2019-03-26 2019-05-07 N
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Health 2019-03-27 2019-04-30 N
Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. Health 2019-03-27 2019-04-30 N
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2019-03-27 2019-04-30 N
Provide and implement an infection prevention and control program. Health 2019-03-27 2019-04-30 N
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2023-01-25 Not Fixed N
Provide safe, appropriate pain management for a resident who requires such services. Health 2023-01-25 Not Fixed N
Ensure medication error rates are not 5 percent or greater. Health 2023-01-25 Not Fixed N
Ensure that residents are free from significant medication errors. Health 2023-01-25 Not Fixed 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 2023-01-25 Not Fixed N