Deficiency Records for Embassy Manor at Edison Nursing and Rehabilitation
Updated as of March 01, 2024
A list of the most recent deficiencies for Embassy Manor at Edison Nursing and Rehabilitation. 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 approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2023-03-10 | 2023-04-19 | N |
| Properly provide smoke detection systems in areas open to corridors. | Fire Safety | 2023-03-10 | 2023-03-30 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2023-03-10 | 2023-03-28 | N |
| Install proper backup exit lighting. | Fire Safety | 2023-03-10 | 2023-03-16 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2023-03-10 | 2023-03-16 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2023-03-10 | 2023-03-14 | 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 | 2023-03-10 | 2023-03-14 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-03-10 | 2023-03-14 | 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 | 2023-03-10 | 2023-03-14 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2023-03-10 | 2023-03-14 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-03-10 | 2023-03-14 | N |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2023-03-10 | 2023-03-14 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-03-10 | 2023-03-14 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-03-10 | 2023-03-14 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2023-03-10 | 2023-03-14 | 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 | 2023-03-10 | 2023-03-14 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2023-03-10 | 2023-03-14 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-03-10 | 2023-03-14 | N |
| Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | Health | 2021-02-26 | 2021-04-16 | N |
| Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | Health | 2021-02-26 | 2021-04-16 | 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 | 2021-02-26 | 2021-04-16 | N |
| Have elevators that firefighters can control in the event of a fire. | Fire Safety | 2021-02-26 | 2021-04-16 | N |
| Provide and implement an infection prevention and control program. | Health | 2021-02-26 | 2021-04-05 | 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 | 2019-04-10 | 2019-05-08 | N |
| Provide appropriate foot care. | Health | 2019-04-10 | 2019-05-08 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2019-04-10 | 2019-05-08 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2019-04-10 | 2019-05-08 | N |
| Have a complete alarm system manually initiated and initiated by fire sprinkler system connection. | Fire Safety | 2019-04-10 | 2019-05-08 | N |
| Properly install and monitor supervisory attachments on automatic sprinkler systems. | Fire Safety | 2019-04-10 | 2019-05-08 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2019-04-10 | 2019-05-08 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2019-04-10 | 2019-05-08 | N |
