Deficiency Records for Koester Pavilion
Updated as of January 01, 2021
This is not the most recent data for Koester Pavilion. For the most recent information, click here.
A list of the most recent deficiencies for Koester Pavilion. 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? |
|---|---|---|---|---|
| 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 | 2019-08-21 | 2019-09-16 | N |
| Have exits that are accessible at all times. | Fire Safety | 2019-08-21 | 2019-09-16 | N |
| Have protected exits that allow the resident to escape the building. | Fire Safety | 2019-08-21 | 2019-09-16 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2019-08-21 | 2019-09-16 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2019-08-21 | 2019-09-16 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2019-08-21 | 2019-09-16 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2019-08-22 | 2019-09-16 | N |
| Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death. | Health | 2019-08-22 | 2019-09-16 | 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 | 2019-08-22 | 2019-09-16 | N |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2019-08-22 | 2019-09-16 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2019-08-22 | 2019-09-16 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2019-08-22 | 2019-09-16 | N |
| Provide timely, quality laboratory services/tests to meet the needs of residents. | Health | 2019-08-22 | 2019-09-16 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2019-08-22 | 2019-09-16 | N |
| 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 | 2019-02-14 | 2019-02-25 | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2018-10-04 | 2018-10-25 | Y |
| 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 | 2018-07-16 | 2018-08-17 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2018-07-16 | 2018-08-17 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2018-07-16 | 2018-08-17 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2018-07-19 | 2018-08-17 | 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 | 2018-07-19 | 2018-08-17 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2018-07-19 | 2018-08-17 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2018-07-19 | 2018-08-17 | 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 | 2018-07-19 | 2018-08-17 | N |
| Provide timely, quality laboratory services/tests to meet the needs of residents. | Health | 2018-07-19 | 2018-08-17 | N |
| Provide and implement an infection prevention and control program. | Health | 2018-07-19 | 2018-08-17 | N |
| Implement a program that monitors antibiotic use. | Health | 2018-07-19 | 2018-08-17 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2018-07-05 | 2018-08-17 | Y |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2017-05-17 | 2017-07-15 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2017-05-17 | 2017-07-15 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2017-05-17 | 2017-07-15 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2017-05-17 | 2017-07-15 | N |
| 1) Hire only people with no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents. | Health | 2017-05-18 | 2017-07-15 | N |
| Develop and implement policies for 1) screening and training employees; and the 2) prevention, identification, investigation, and reporting of any abuse, neglect, mistreatment and misappropriation of property. | Health | 2017-05-18 | 2017-07-15 | N |
| Ensure residents maintain acceptable nutritional status. | Health | 2017-05-18 | 2017-07-15 | N |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2017-05-18 | 2017-07-15 | N |
