Deficiency Records for Mount Holly Rehabilitation and Healthcare Center
Updated as of April 01, 2024
A list of the most recent deficiencies for Mount Holly Rehabilitation and Healthcare 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? |
|---|---|---|---|---|
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2023-05-20 | 2023-06-27 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2023-05-20 | 2023-06-27 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2023-05-20 | 2023-06-27 | N |
| Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. | Health | 2023-05-20 | 2023-06-27 | N |
| PASARR screening for Mental disorders or Intellectual Disabilities | Health | 2023-05-20 | 2023-06-27 | 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 | 2023-05-20 | 2023-06-27 | N |
| Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | Health | 2023-05-20 | 2023-06-27 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-05-20 | 2023-06-27 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-05-20 | 2023-06-27 | 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 | 2023-05-20 | 2023-06-27 | 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 | 2023-05-20 | 2023-06-27 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2023-05-20 | 2023-06-27 | N |
| Provide timely, quality laboratory services/tests to meet the needs of residents. | Health | 2023-05-20 | 2023-06-27 | N |
| Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. | Health | 2023-05-20 | 2023-06-27 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-05-20 | 2023-06-27 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2023-03-02 | 2023-04-12 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-03-02 | 2023-04-12 | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2023-03-02 | 2023-04-12 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2022-06-15 | 2022-07-29 | Y |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2022-06-15 | 2022-07-29 | 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 | 2022-06-15 | 2022-07-29 | Y |
| Install a fire alarm system that can be heard throughout the facility. | Fire Safety | 2021-05-12 | 2021-07-30 | N |
| Properly install and monitor supervisory attachments on automatic sprinkler systems. | Fire Safety | 2021-05-12 | 2021-07-30 | N |
| Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | Health | 2021-05-12 | 2021-05-19 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2021-05-12 | 2021-05-14 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2019-07-18 | 2019-08-31 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2019-07-18 | 2019-08-31 | N |
