A list of the most recent deficiencies for Forrest Oakes Healthcare 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? |
|---|---|---|---|---|
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2023-12-06 | 2024-01-19 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-12-06 | 2024-01-19 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2023-12-06 | 2024-01-19 | N |
| Meet requirements for the installation and maintenance of electrical systems. | Fire Safety | 2023-12-06 | 2024-01-19 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-12-06 | 2024-01-19 | N |
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2023-11-02 | 2023-11-28 | N |
| Honor the resident's right to organize and participate in resident/family groups in the facility. | Health | 2023-11-02 | 2023-11-28 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2023-11-02 | 2023-11-28 | N |
| Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. | Health | 2023-11-02 | 2023-11-28 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2023-11-02 | 2023-11-28 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2023-11-02 | 2023-11-28 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-11-02 | 2023-11-28 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2023-11-02 | 2023-11-28 | N |
| Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. | Health | 2023-11-02 | 2023-11-28 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2023-11-02 | 2023-11-28 | Y |
| Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | Health | 2023-11-02 | 2023-11-28 | 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 | 2023-11-02 | 2023-11-28 | Y |
| Ensure meals and snacks are served at times in accordance with resident?s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. | Health | 2023-11-02 | 2023-11-28 | Y |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2022-12-07 | 2023-01-31 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2022-12-07 | 2023-01-21 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-12-07 | 2023-01-21 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2022-12-07 | 2023-01-21 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2022-12-07 | 2023-01-21 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2022-12-07 | 2023-01-21 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2022-11-10 | 2022-12-23 | N |
| Keep residents' personal and medical records private and confidential. | Health | 2022-11-10 | 2022-12-23 | 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 | 2022-11-10 | 2022-12-23 | N |
| Ensure each resident receives an accurate assessment. | Health | 2022-11-10 | 2022-12-23 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2022-11-10 | 2022-12-23 | 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 | 2022-11-10 | 2022-12-23 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2022-11-10 | 2022-12-23 | N |
| Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. | Health | 2022-11-10 | 2022-12-23 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-11-10 | 2022-12-23 | N |
| Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. | Health | 2022-11-10 | 2022-12-23 | N |
| Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. | Health | 2022-11-10 | 2022-12-23 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-11-10 | 2022-12-23 | Y |
| Honor the resident's right to organize and participate in resident/family groups in the facility. | Health | 2022-11-10 | 2022-12-08 | N |
| Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | Health | 2022-11-10 | 2022-12-08 | 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 | 2022-11-10 | 2022-12-08 | 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 | 2022-11-10 | 2022-12-02 | N |
| Provide safe, appropriate pain management for a resident who requires such services. | Health | 2022-05-06 | 2022-05-06 | Y |
| Have exits that are accessible at all times. | Fire Safety | 2021-06-02 | 2021-06-25 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2021-06-02 | 2021-06-25 | N |
| Ensure each resident receives an accurate assessment. | Health | 2021-05-20 | 2021-06-05 | N |
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2021-05-20 | 2021-06-05 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-05-20 | 2021-06-05 | N |
| Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. | Health | 2021-05-20 | 2021-06-05 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2021-05-20 | 2021-06-05 | 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 | 2021-05-20 | 2021-06-05 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2021-05-20 | 2021-06-05 | 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 | 2021-05-20 | 2021-06-05 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2021-05-20 | 2021-06-05 | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2021-05-20 | 2021-06-05 | Y |
| Ensure that residents are free from significant medication errors. | Health | 2021-03-05 | 2021-03-23 | Y |
