Deficiency Records for The Grand Rehabilitation and Nrsg at Guilderland
Updated as of March 01, 2024
A list of the most recent deficiencies for The Grand Rehabilitation and Nrsg at Guilderland. 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? |
|---|---|---|---|---|
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-01-19 | 2023-03-21 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2022-10-26 | 2022-12-24 | Y |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2022-10-26 | 2022-12-24 | Y |
| Ensure that residents are free from significant medication errors. | Health | 2022-10-26 | 2022-12-24 | Y |
| 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 | 2022-10-26 | 2022-12-24 | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2022-10-26 | 2022-12-24 | Y |
| 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 | 2022-05-23 | 2022-07-22 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2021-12-13 | 2022-01-21 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2021-12-13 | 2022-01-21 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2021-08-23 | 2021-10-08 | 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 | 2021-08-23 | 2021-10-08 | N |
| Ensure each resident receives an accurate assessment. | Health | 2021-08-23 | 2021-10-08 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2021-08-23 | 2021-10-08 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2021-08-23 | 2021-10-08 | 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 | 2021-08-23 | 2021-10-08 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2021-08-23 | 2021-10-08 | 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 | 2021-08-23 | 2021-10-08 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2021-08-23 | 2021-10-08 | N |
| Have a policy regarding use and storage of foods brought to residents by family and other visitors. | Health | 2021-08-23 | 2021-10-08 | N |
| Provide and implement an infection prevention and control program. | Health | 2021-08-23 | 2021-10-08 | N |
| Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. | Health | 2021-08-23 | 2021-10-08 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2021-08-23 | 2021-10-08 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2021-08-23 | 2021-10-08 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2021-08-23 | 2021-10-08 | Y |
| Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | Health | 2021-08-23 | 2021-10-08 | Y |
| Ensure that residents are free from significant medication errors. | Health | 2021-08-23 | 2021-10-08 | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2021-08-23 | 2021-10-08 | Y |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2021-08-23 | 2021-10-08 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2021-08-23 | 2021-10-08 | N |
| Have a battery powered remote alarm panel in a location accessible by operating personnel. | Fire Safety | 2021-08-23 | 2021-10-08 | N |
| Ensure that testing and maintenance of electrical equipment is performed. | Fire Safety | 2021-08-23 | 2021-10-08 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2021-08-26 | 2021-09-30 | Y |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2019-08-27 | 2020-02-11 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2019-08-27 | 2019-10-22 | N |
| Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | Health | 2019-08-27 | 2019-10-22 | 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 | 2019-08-27 | 2019-10-22 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2019-08-27 | 2019-10-22 | N |
| PASARR screening for Mental disorders or Intellectual Disabilities | Health | 2019-08-27 | 2019-10-22 | N |
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2019-08-27 | 2019-10-22 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2019-08-27 | 2019-10-22 | N |
| Provide activities to meet all resident's needs. | Health | 2019-08-27 | 2019-10-22 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2019-08-27 | 2019-10-22 | 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 | 2019-08-27 | 2019-10-22 | 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 | 2019-08-27 | 2019-10-22 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2019-08-27 | 2019-10-22 | N |
| Have a policy regarding use and storage of foods brought to residents by family and other visitors. | Health | 2019-08-27 | 2019-10-22 | N |
| Ensure the facility is licensed under applicable State and local law and operates and provides services in compliance with all applicable Federal, State, and local laws, regulations, and codes, and with accepted professional standards. | Health | 2019-08-27 | 2019-10-22 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2019-08-27 | 2019-10-22 | N |
| Provide and implement an infection prevention and control program. | Health | 2019-08-27 | 2019-10-22 | N |
| Establish policies and procedures for medical documentation. | Fire Safety | 2019-08-27 | 2019-10-22 | N |
| Provide family notifications of emergency plan. | Fire Safety | 2019-08-27 | 2019-10-22 | N |
| Establish staff and initial training requirements. | Fire Safety | 2019-08-27 | 2019-10-22 | 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 | 2019-08-27 | 2019-10-22 | N |
| Have an enclosure around a vertical opening shaft. | Fire Safety | 2019-08-27 | 2019-10-22 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2019-08-27 | 2019-10-22 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2019-08-27 | 2019-10-22 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2019-08-27 | 2019-10-22 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2019-08-27 | 2019-10-22 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2019-08-27 | 2019-10-22 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2019-08-27 | 2019-10-22 | N |
| Ensure that testing and maintenance of electrical equipment is performed. | Fire Safety | 2019-08-27 | 2019-10-22 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2019-08-27 | 2019-10-22 | N |
| Keep residents' personal and medical records private and confidential. | Health | 2018-02-22 | 2018-04-19 | 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 | 2018-02-22 | 2018-04-19 | N |
| Not hire anyone with a finding of abuse, neglect, exploitation, or theft. | Health | 2018-02-22 | 2018-04-19 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2018-02-22 | 2018-04-19 | N |
| Notify the resident or the resident?s representative in writing how long the nursing home will hold the resident?s bed in cases of transfer to a hospital or therapeutic leave. | Health | 2018-02-22 | 2018-04-19 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2018-02-22 | 2018-04-19 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2018-02-22 | 2018-04-19 | N |
| Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. | Health | 2018-02-22 | 2018-04-19 | 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 | 2018-02-22 | 2018-04-19 | 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 | 2018-02-22 | 2018-04-19 | N |
| Ensure that residents are free from significant medication errors. | Health | 2018-02-22 | 2018-04-19 | 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 | 2018-02-22 | 2018-04-19 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2018-02-22 | 2018-04-19 | N |
| Provide and implement an infection prevention and control program. | Health | 2018-02-22 | 2018-04-19 | N |
| Keep all essential equipment working safely. | Health | 2018-02-22 | 2018-04-19 | N |
| Establish procedures for tracking staff and patients during an emergency. | Fire Safety | 2018-02-22 | 2018-04-19 | N |
| Establish policies and procedures for volunteers. | Fire Safety | 2018-02-22 | 2018-04-19 | N |
| Provide family notifications of emergency plan. | Fire Safety | 2018-02-22 | 2018-04-19 | N |
| Conduct testing and exercise requirements. | Fire Safety | 2018-02-22 | 2018-04-19 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2018-02-22 | 2018-04-19 | N |
| Have an enclosure around a vertical opening shaft. | Fire Safety | 2018-02-22 | 2018-04-19 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2018-02-22 | 2018-04-19 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2018-02-22 | 2018-04-19 | N |
