A list of the most recent deficiencies for Madeira 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? |
|---|---|---|---|---|
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2022-12-08 | 2023-01-12 | Y |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2022-12-08 | 2023-01-12 | Y |
| Provide and implement an infection prevention and control program. | Health | 2022-12-08 | 2023-01-12 | Y |
| Respond appropriately to all alleged violations. | Health | 2022-08-11 | 2022-09-02 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2022-08-11 | 2022-09-02 | Y |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2022-08-11 | 2022-09-02 | Y |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2022-08-11 | 2022-09-02 | Y |
| Ensure that residents are free from significant medication errors. | Health | 2022-08-11 | 2022-09-02 | Y |
| Provide and implement an infection prevention and control program. | Health | 2022-08-11 | 2022-09-02 | 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 | 2022-04-04 | 2022-05-06 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2022-04-04 | 2022-05-06 | 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 | 2022-04-04 | 2022-05-06 | N |
| Assist a resident in gaining access to vision and hearing services. | Health | 2022-04-04 | 2022-05-06 | 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 | 2022-04-04 | 2022-05-06 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2022-04-04 | 2022-05-06 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2022-04-04 | 2022-05-06 | 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 | 2022-04-04 | 2022-05-06 | N |
| Ensure that residents are free from significant medication errors. | Health | 2022-04-04 | 2022-05-06 | 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 | 2022-04-04 | 2022-05-06 | N |
| Provide or obtain dental services for each resident. | Health | 2022-04-04 | 2022-05-06 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-04-04 | 2022-05-06 | N |
| Dispose of garbage and refuse properly. | Health | 2022-04-04 | 2022-05-06 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-04-04 | 2022-05-06 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2022-04-04 | 2022-05-06 | 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 | 2022-04-04 | 2022-05-06 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-04-04 | 2022-05-06 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-04-04 | 2022-05-06 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-04-04 | 2022-05-06 | Y |
| Provide safe, appropriate pain management for a resident who requires such services. | Health | 2022-04-04 | 2022-05-06 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-03-02 | 2022-05-06 | Y |
| Ensure that residents are free from significant medication errors. | Health | 2022-03-02 | 2022-05-06 | Y |
| Provide and implement an infection prevention and control program. | Health | 2022-03-02 | 2022-05-06 | Y |
| Address subsistence needs for staff and patients. | Fire Safety | 2022-03-29 | 2022-05-06 | N |
| Establish emergency prep training and testing. | Fire Safety | 2022-03-29 | 2022-05-06 | N |
| Establish staff and initial training requirements. | Fire Safety | 2022-03-29 | 2022-05-06 | N |
| Conduct testing and exercise requirements. | Fire Safety | 2022-03-29 | 2022-05-06 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2022-03-29 | 2022-05-06 | 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 | 2022-03-29 | 2022-05-06 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2022-03-29 | 2022-05-06 | N |
| Have properly located and lighted "Exit" signs. | Fire Safety | 2022-03-29 | 2022-05-06 | 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 | 2022-03-29 | 2022-05-06 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2022-03-29 | 2022-05-06 | N |
| Install a fire alarm system that can be heard throughout the facility. | Fire Safety | 2022-03-29 | 2022-05-06 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2022-03-29 | 2022-05-06 | N |
| Follow proper procedures when the fire alarm was out of service for more than 4 hours. | Fire Safety | 2022-03-29 | 2022-05-06 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-03-29 | 2022-05-06 | N |
| Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2022-03-29 | 2022-05-06 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2022-03-29 | 2022-05-06 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2022-03-29 | 2022-05-06 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2022-03-29 | 2022-05-06 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2022-03-29 | 2022-05-06 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2022-03-29 | 2022-05-06 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2022-03-29 | 2022-05-06 | N |
| Provide timely, quality laboratory services/tests to meet the needs of residents. | Health | 2022-03-02 | 2022-04-04 | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2022-03-02 | 2022-04-04 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2019-04-25 | 2019-06-05 | N |
| Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death. | Health | 2019-04-25 | 2019-06-05 | 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 | 2019-04-25 | 2019-06-05 | N |
| Ensure each resident receives an accurate assessment. | Health | 2019-04-25 | 2019-06-05 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2019-04-25 | 2019-06-05 | N |
| Provide and implement an infection prevention and control program. | Health | 2019-04-25 | 2019-06-05 | N |
| Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame. | Health | 2019-04-25 | 2019-06-05 | 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 | 2019-04-26 | 2019-06-05 | N |
| Have exits that are accessible at all times. | Fire Safety | 2019-04-26 | 2019-06-05 | N |
| Install a fire alarm system that can be heard throughout the facility. | Fire Safety | 2019-04-26 | 2019-06-05 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2019-04-26 | 2019-06-05 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2019-04-26 | 2019-06-05 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2019-04-26 | 2019-06-05 | N |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2018-03-01 | 2018-04-13 | N |
| Encode each resident?s assessment data and transmit these data to the State within 7 days of assessment. | Health | 2018-03-01 | 2018-04-13 | N |
| Ensure each resident receives an accurate assessment. | Health | 2018-03-01 | 2018-04-13 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2018-03-01 | 2018-04-13 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2018-03-01 | 2018-04-13 | N |
| Provide and implement an infection prevention and control program. | Health | 2018-03-01 | 2018-04-13 | 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 | 2018-03-02 | 2018-04-13 | 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 | 2018-03-02 | 2018-04-13 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2018-03-02 | 2018-04-13 | N |
