Deficiency Records for St Luke Residential Health Care Facility Inc
Updated as of April 01, 2024
A list of the most recent deficiencies for St Luke Residential Health Care Facility Inc. 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 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 | 2023-12-28 | 2024-02-25 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2023-06-09 | 2023-08-07 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2023-06-09 | 2023-08-07 | Y |
| Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. | Health | 2023-05-03 | 2023-07-01 | Y |
| Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. | Health | 2023-04-13 | 2023-06-11 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-04-13 | 2023-06-11 | 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 | 2023-04-13 | 2023-06-11 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-04-13 | 2023-06-11 | Y |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2023-04-11 | 2023-06-10 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-04-11 | 2023-06-10 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-04-27 | 2022-06-24 | 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 | 2021-04-09 | 2021-06-07 | 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 | 2021-04-09 | 2021-06-07 | 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 | 2021-04-09 | 2021-06-07 | N |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2021-04-09 | 2021-06-07 | N |
| Provide and implement an infection prevention and control program. | Health | 2021-04-09 | 2021-06-07 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2021-04-09 | 2021-06-07 | 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 | 2021-04-09 | 2021-06-07 | N |
| Have properly installed hallway dispensers for alcohol-based hand rub. | Fire Safety | 2021-04-09 | 2021-06-07 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2021-04-09 | 2021-06-07 | N |
| Have elevators that firefighters can control in the event of a fire. | Fire Safety | 2021-04-09 | 2021-06-07 | N |
| Ensure that building systems meet requirements determined by risk assessment procedures performed by qualified personnel. | Fire Safety | 2021-04-09 | 2021-06-07 | N |
| Ensure that testing and maintenance of electrical equipment is performed. | Fire Safety | 2021-04-09 | 2021-06-07 | 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 | 2019-01-18 | 2019-03-19 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2019-01-18 | 2019-03-19 | 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 | 2019-01-18 | 2019-03-19 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2019-01-18 | 2019-03-19 | N |
| Meet requirements for outpatient facilities located next to inpatient facilities separated by fire resistive construction. | Fire Safety | 2019-01-17 | 2019-03-18 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2019-01-17 | 2019-03-18 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2019-01-17 | 2019-03-18 | N |
| Have a battery powered remote alarm panel in a location accessible by operating personnel. | Fire Safety | 2019-01-17 | 2019-03-18 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2019-01-17 | 2019-03-18 | N |
| Ensure that testing and maintenance of electrical equipment is performed. | Fire Safety | 2019-01-17 | 2019-03-18 | N |
