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Deficiency Records for Saint Luke Lutheran Home

View the most recent health deficiencies and inspection results for Saint Luke Lutheran Home. Stay informed about quality of care issues.

View the most recent health deficiencies and inspection results for Saint Luke Lutheran Home. Stay informed about quality of care issues.

Deficiency Type of Deficiency Deficiency Date Date Corrected Resulted from a Complaint?
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 2026-03-10 2026-04-15 Y
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2026-03-10 2026-04-15 Y
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Health 2026-03-10 2026-04-15 Y
Keep all essential equipment working safely. Health 2026-03-10 2026-04-15 Y
Administer the facility in a manner that enables it to use its resources effectively and efficiently. Health 2026-03-10 2026-04-15 Y
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Health 2026-03-10 2026-04-15 Y
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Health 2026-03-10 2026-04-15 Y
Ensure that residents are free from significant medication errors. Health 2026-03-10 2026-04-15 Y
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Health 2026-03-10 2026-04-15 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2026-03-10 2026-04-15 Y
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2026-03-10 2026-04-15 Y
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2026-03-10 2026-04-15 Y
Provide care and assistance to perform activities of daily living for any resident who is unable. Health 2026-03-10 2026-04-15 Y
Respond appropriately to all alleged violations. Health 2026-03-10 2026-04-15 Y
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Health 2026-03-10 2026-04-15 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 2026-01-30 2026-02-13 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 2026-01-30 2026-02-13 Y
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2026-01-05 2026-01-13 Y
Keep residents' personal and medical records private and confidential. Health 2026-01-05 2026-01-13 Y
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Health 2026-01-05 2026-01-13 Y
Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made. Health 2025-11-24 2026-01-05 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2025-11-24 2026-01-05 Y
Ensure that residents are free from significant medication errors. Health 2025-11-24 2026-01-05 Y
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Health 2025-10-14 2026-01-05 Y
Provide care and assistance to perform activities of daily living for any resident who is unable. Health 2025-08-04 2025-09-25 Y
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2025-08-04 2025-09-25 Y
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted Health 2025-08-04 2025-09-25 Y
Ensure each resident receives an accurate assessment. Health 2025-08-04 2025-09-25 Y
Respond appropriately to all alleged violations. Health 2025-08-04 2025-09-25 Y
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Health 2025-08-04 2025-09-25 Y
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 2025-08-04 2025-09-25 Y
Honor the resident's right to manage his or her financial affairs. Health 2025-08-04 2025-09-25 Y
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Health 2025-08-04 2025-09-25 Y
Keep all essential equipment working safely. Health 2025-09-11 2025-09-25 Y
Provide and implement an infection prevention and control program. Health 2025-09-11 2025-09-25 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 2025-09-11 2025-09-25 Y
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2025-09-11 2025-09-25 Y
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Health 2025-09-11 2025-09-25 Y
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2025-09-11 2025-09-25 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 2025-09-11 2025-09-25 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2025-08-04 2025-09-25 Y
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2025-05-12 2025-09-25 Y
Have restrictions on the use of portable space heaters. Fire Safety 2025-05-29 2025-09-25 Y
Have approved installation, maintenance and testing program for fire alarm systems. Fire Safety 2025-05-19 2025-09-25 Y
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2025-05-12 2025-09-25 Y
Provide care and assistance to perform activities of daily living for any resident who is unable. Health 2025-05-12 2025-09-25 Y
Post nurse staffing information every day. Health 2025-05-12 2025-09-25 Y
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Health 2025-05-12 2025-09-25 Y
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Health 2025-08-04 2025-09-25 Y
Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility. Health 2025-08-04 2025-09-25 Y
Administer the facility in a manner that enables it to use its resources effectively and efficiently. Health 2025-08-04 2025-09-25 Y
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Health 2025-08-04 2025-09-25 Y
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Health 2025-08-04 2025-09-25 Y
Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. Health 2025-08-04 2025-09-25 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 2025-08-04 2025-09-25 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2025-03-10 2025-04-02 Y
Have stairways and smokeproof enclosures used as exits that meet safety requirements. Fire Safety 2023-01-30 2023-03-07 N
Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. Health 2023-01-30 2023-03-07 N
Implement a program that monitors antibiotic use. Health 2023-01-30 2023-03-07 N
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2023-01-30 2023-03-07 N
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2023-01-30 2023-03-07 N
Provide care and assistance to perform activities of daily living for any resident who is unable. Health 2023-01-30 2023-03-07 N
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Health 2023-01-30 2023-03-07 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 2023-01-30 2023-03-07 N
Ensure that waiting areas, nurse?s stations, gift shops, and cooking facilities, open to the corridor are properly protected. Fire Safety 2023-01-30 2023-03-07 N
Ensure smoke barriers are constructed to a 1 hour fire resistance rating. Fire Safety 2023-01-30 2023-03-07 N
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. Fire Safety 2023-01-30 2023-03-07 N
Provide a written emergency evacuation plan. Fire Safety 2023-01-30 2023-03-07 N
Have generator or other power source capable of supplying service within 10 seconds. Fire Safety 2023-01-30 2023-03-07 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 2020-02-06 2020-03-09 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 2020-02-06 2020-03-09 N
Observe each nurse aide's job performance and give regular training. Health 2020-02-06 2020-03-09 N
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Health 2020-02-06 2020-03-09 N
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2020-02-06 2020-03-09 N
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2020-02-06 2020-03-09 N
PASARR screening for Mental disorders or Intellectual Disabilities Health 2020-02-06 2020-03-09 N
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. Health 2020-02-06 2020-03-09 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 2020-02-06 2020-03-09 N
Inspect, test, and maintain automatic sprinkler systems. Fire Safety 2020-02-06 2020-03-09 N
Ensure smoke barriers are constructed to a 1 hour fire resistance rating. Fire Safety 2020-02-06 2020-03-09 N
Have restrictions on the use of highly flammable decorations. Fire Safety 2020-02-06 2020-03-09 N
Have a battery powered remote alarm panel in a location accessible by operating personnel. Fire Safety 2020-02-06 2020-03-09 N
Have generator or other power source capable of supplying service within 10 seconds. Fire Safety 2020-02-06 2020-03-09 N
Ensure proper usage of power strips and extension cords. Fire Safety 2020-02-06 2020-03-09 N
Have proper medical gas storage and administration areas. Fire Safety 2020-02-06 2020-03-09 N
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Health 2020-02-06 2020-03-09 N
Provide and implement an infection prevention and control program. Health 2020-02-06 2020-03-09 N
Provide safe, appropriate pain management for a resident who requires such services. Health 2019-01-16 2019-02-19 N
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Health 2019-01-16 2019-02-19 N
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2019-01-16 2019-02-19 N
Provide and implement an infection prevention and control program. Health 2019-01-16 2019-02-19 N
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2019-01-16 2019-02-19 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 2019-01-16 2019-02-19 N
Ensure medication error rates are not 5 percent or greater. Health 2019-01-16 2019-02-19 N
Provide or obtain dental services for each resident. Health 2019-01-16 2019-02-19 N
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Health 2019-01-16 2019-02-19 N
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2019-01-16 2019-02-19 N
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. Fire Safety 2019-01-16 2019-02-19 N
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2019-01-16 2019-02-19 N
Provide care and assistance to perform activities of daily living for any resident who is unable. Health 2019-01-16 2019-02-19 N
Respond appropriately to all alleged violations. Health 2019-01-16 2019-02-19 N
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Health 2019-01-16 2019-02-19 N
Develop and maintain an Emergency Preparedness Program (EP). Fire Safety 2019-01-16 2019-02-19 N
Conduct testing and exercise requirements. Fire Safety 2019-01-16 2019-02-19 N
Meet requirements for sections of health care facilities separated by fire resistive construction. Fire Safety 2019-01-16 2019-02-19 N
Use approved construction type or materials. Fire Safety 2019-01-16 2019-02-19 N
Inspect, test, and maintain automatic sprinkler systems. Fire Safety 2019-01-16 2019-02-19 N
To conduct inspection, testing and maintenance of fire doors by qualified individuals. Fire Safety 2019-01-16 2019-02-19 N

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