A list of the most recent deficiencies for Las Estancias By Pure Health. 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? |
|---|---|---|---|---|
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2023-11-17 | 2024-01-05 | Y |
| 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 | 2023-11-17 | 2024-01-05 | 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 | 2023-11-17 | 2024-01-05 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-11-17 | 2024-01-05 | N |
| Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector. | Fire Safety | 2023-11-14 | 2023-12-28 | N |
| Have properly installed hallway dispensers for alcohol-based hand rub. | Fire Safety | 2023-11-14 | 2023-12-15 | N |
| Provide safe, appropriate pain management for a resident who requires such services. | Health | 2023-07-10 | 2023-08-18 | Y |
| Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. | Health | 2022-12-28 | 2023-01-20 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2022-08-22 | 2022-09-22 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-08-22 | 2022-09-22 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2022-08-22 | 2022-09-22 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-08-22 | 2022-09-22 | N |
| Assist a resident in gaining access to vision and hearing services. | Health | 2022-08-22 | 2022-09-22 | N |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2022-08-22 | 2022-09-22 | N |
| Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. | Health | 2022-08-22 | 2022-09-22 | N |
| Provide medically-related social services to help each resident achieve the highest possible quality of life. | Health | 2022-08-22 | 2022-09-22 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2022-08-22 | 2022-09-22 | 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 | 2022-08-22 | 2022-09-22 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2022-08-22 | 2022-09-22 | N |
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2022-08-22 | 2022-09-22 | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2022-08-22 | 2022-09-22 | Y |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2022-08-16 | 2022-09-16 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2022-08-16 | 2022-09-16 | 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 | 2021-04-28 | 2021-07-09 | N |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2021-04-28 | 2021-07-09 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2021-04-28 | 2021-07-09 | 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 | 2021-04-28 | 2021-07-09 | N |
| Address patient/client population and determine types of services needed. | Fire Safety | 2021-05-04 | 2021-06-04 | N |
| Follow proper procedures when the fire alarm was out of service for more than 4 hours. | Fire Safety | 2021-05-04 | 2021-06-04 | N |
| Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2021-05-04 | 2021-06-04 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2021-05-04 | 2021-06-04 | N |
| Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk. | Fire Safety | 2021-05-04 | 2021-06-04 | N |
