Deficiency Records for Fort Bayard Medical Center

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Updated as of March 01, 2022

This is not the most recent data for Fort Bayard Medical Center. For the most recent information, click here.

A list of the most recent deficiencies for Fort Bayard Medical 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?
Inspect, test, and maintain automatic sprinkler systems. Fire Safety 2021-02-03 2021-04-01 N
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. Fire Safety 2021-02-03 2021-04-01 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 2021-01-27 2021-03-31 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 2021-01-27 2021-03-31 N
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. Health 2019-06-28 2019-08-21 N
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. Health 2019-06-28 2019-08-21 N
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2019-06-28 2019-08-21 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 2019-06-28 2019-08-21 N
Ensure services provided by the nursing facility meet professional standards of quality. Health 2019-06-28 2019-08-21 N
Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. Health 2019-06-28 2019-08-21 N
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Health 2019-06-28 2019-08-21 N
Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents. Health 2019-06-28 2019-08-21 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 2019-06-28 2019-08-21 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 2019-06-28 2019-08-21 N
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2019-06-28 2019-08-21 N
Provide and implement an infection prevention and control program. Health 2019-06-28 2019-08-21 N
Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation. Health 2019-06-28 2019-08-21 N
Establish procedures for tracking staff and patients during an emergency. Fire Safety 2019-06-25 2019-07-28 N
Establish policies and procedures for volunteers. Fire Safety 2019-06-25 2019-07-28 N
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. Health 2018-05-10 2018-06-15 N
Honor the resident's right to organize and participate in resident/family groups in the facility. Health 2018-05-10 2018-06-15 N
The resident has the right to receive notices in a format and a language he or she understands. Health 2018-05-10 2018-06-15 N
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. Health 2018-05-10 2018-06-15 N
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Health 2018-05-10 2018-06-15 N
Ensure each resident receives an accurate assessment. Health 2018-05-10 2018-06-15 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 2018-05-10 2018-06-15 N
Provide safe and appropriate respiratory care for a resident when needed. Health 2018-05-10 2018-06-15 N
Provide safe, appropriate dialysis care/services for a resident who requires such services. Health 2018-05-10 2018-06-15 N
Observe each nurse aide's job performance and give regular training. Health 2018-05-10 2018-06-15 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 2018-05-10 2018-06-15 N
Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations and emergencies. Health 2018-05-10 2018-06-15 N
Provide and implement an infection prevention and control program. Health 2018-05-10 2018-06-15 N
Implement a program that monitors antibiotic use. Health 2018-05-10 2018-06-15 N
Install an approved automatic sprinkler system. Fire Safety 2018-05-09 2018-06-15 N
Properly select, install, inspect, or maintain portable fire extinguishes. Fire Safety 2018-05-09 2018-06-15 N