A list of the most recent deficiencies for Fieldston Lodge 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? |
|---|---|---|---|---|
| Use approved construction type or materials. | Fire Safety | 2022-03-02 | 2022-08-15 | 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 | 2022-03-02 | 2022-04-29 | N |
| Ensure each resident receives an accurate assessment. | Health | 2022-03-02 | 2022-04-29 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-03-02 | 2022-04-29 | 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 | 2022-03-02 | 2022-04-29 | N |
| Provide safe, appropriate pain management for a resident who requires such services. | Health | 2022-03-02 | 2022-04-29 | N |
| Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. | Health | 2022-03-02 | 2022-04-29 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2022-03-02 | 2022-04-29 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2022-03-02 | 2022-04-29 | 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 | 2022-03-02 | 2022-04-29 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-03-02 | 2022-04-29 | N |
| Respond appropriately to all alleged violations. | Health | 2022-03-02 | 2022-04-29 | Y |
| Establish procedures for tracking staff and patients during an emergency. | Fire Safety | 2022-03-02 | 2022-04-29 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-03-02 | 2022-04-29 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2022-03-02 | 2022-04-29 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2022-03-02 | 2022-04-29 | N |
| Have an enclosure around a vertical opening shaft. | Fire Safety | 2022-03-02 | 2022-03-29 | 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 | 2019-07-16 | 2019-09-12 | N |
| Ensure each resident receives an accurate assessment. | Health | 2019-07-16 | 2019-09-12 | 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 | 2019-07-16 | 2019-09-12 | 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 | 2019-07-16 | 2019-09-12 | 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 | 2019-07-16 | 2019-09-12 | N |
| Provide and implement an infection prevention and control program. | Health | 2019-07-16 | 2019-09-12 | N |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2019-07-16 | 2019-09-12 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2019-07-16 | 2019-09-12 | N |
| Have ramps, exits, fire escape ladders, steps, and areas of refuge that meet safety requirements. | Fire Safety | 2019-07-16 | 2019-09-12 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2019-07-16 | 2019-08-23 | N |
| Assure the security of all personal funds of residents deposited with the facility. | Health | 2019-07-16 | 2019-08-16 | N |
| Provide housekeeping and maintenance services. | Health | 2017-10-25 | 2018-01-02 | N |
| Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2017-10-25 | 2018-01-02 | N |
| Provide care by qualified persons according to each resident's written plan of care. | Health | 2017-10-25 | 2018-01-02 | N |
| Post nurse staffing information/data on a daily basis. | Health | 2017-10-25 | 2018-01-02 | N |
| Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. | Health | 2017-10-25 | 2018-01-02 | N |
| Set up an ongoing quality assessment and assurance group to review quality deficiencies quarterly, and develop corrective plans of action. | Health | 2017-10-25 | 2018-01-02 | 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 | 2017-10-25 | 2017-12-23 | N |
