A list of the most recent deficiencies for Glendora Health Care 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? |
|---|---|---|---|---|
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-11-07 | 2023-11-24 | Y |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2023-11-07 | 2023-11-24 | Y |
| Respond appropriately to all alleged violations. | Health | 2023-11-07 | 2023-11-24 | Y |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-11-07 | 2023-11-24 | 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 | 2023-07-06 | 2023-07-21 | Y |
| Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2023-07-10 | 2023-07-21 | Y |
| Provide a written emergency evacuation plan. | Fire Safety | 2023-07-10 | 2023-07-21 | Y |
| Have a complete alarm system manually initiated and initiated by fire sprinkler system connection. | Fire Safety | 2022-11-15 | 2023-06-21 | 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 | 2023-01-30 | 2023-02-15 | Y |
| Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. | Health | 2023-01-30 | 2023-02-15 | Y |
| Provide and implement an infection prevention and control program. | Health | 2023-01-30 | 2023-02-15 | Y |
| Ensure each resident receives an accurate assessment. | Health | 2023-01-06 | 2023-02-15 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-01-06 | 2023-02-15 | 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 | 2022-11-21 | 2022-12-30 | N |
| Ensure each resident receives an accurate assessment. | Health | 2022-11-21 | 2022-12-30 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-11-21 | 2022-12-30 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-11-21 | 2022-12-30 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-11-21 | 2022-12-30 | N |
| Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. | Health | 2022-11-21 | 2022-12-30 | 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 | 2022-11-21 | 2022-12-30 | 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 | 2022-11-21 | 2022-12-30 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2022-11-21 | 2022-12-30 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-11-21 | 2022-12-30 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2022-11-15 | 2022-12-30 | N |
| Have properly located and lighted "Exit" signs. | Fire Safety | 2022-11-15 | 2022-12-30 | 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 | 2022-11-15 | 2022-12-30 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2022-11-15 | 2022-12-30 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-11-15 | 2022-12-30 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2022-11-15 | 2022-12-30 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2022-11-15 | 2022-12-30 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2022-11-15 | 2022-12-30 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2022-11-15 | 2022-12-30 | N |
| Provide activities to meet all resident's needs. | Health | 2022-08-24 | 2022-08-25 | Y |
| Ensure medication error rates are not 5 percent or greater. | Health | 2022-08-24 | 2022-08-25 | Y |
| Protect each resident from the wrongful use of the resident's belongings or money. | Health | 2022-08-01 | 2022-08-25 | Y |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2022-08-01 | 2022-08-25 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2022-08-01 | 2022-08-25 | Y |
| Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. | Health | 2022-08-01 | 2022-08-25 | Y |
| Ensure medication error rates are not 5 percent or greater. | Health | 2022-08-01 | 2022-08-25 | Y |
| Administer the facility in a manner that enables it to use its resources effectively and efficiently. | Health | 2022-08-01 | 2022-08-25 | Y |
| Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | Health | 2022-08-01 | 2022-08-25 | Y |
| Ensure staff are vaccinated for COVID-19 | Health | 2022-08-01 | 2022-08-25 | 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 | 2019-10-09 | 2019-11-08 | 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 | 2019-10-08 | 2019-11-08 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2019-10-08 | 2019-11-08 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2019-10-08 | 2019-11-08 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2019-10-08 | 2019-11-08 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2019-10-08 | 2019-11-08 | N |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2018-11-15 | 2018-12-07 | N |
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2018-11-15 | 2018-12-07 | N |
| Provide care by qualified persons according to each resident's written plan of care. | Health | 2018-11-15 | 2018-12-07 | N |
| Provide activities to meet all resident's needs. | Health | 2018-11-15 | 2018-12-07 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2018-11-15 | 2018-12-07 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2018-11-15 | 2018-12-07 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2018-11-15 | 2018-12-07 | N |
| Post nurse staffing information every day. | Health | 2018-11-15 | 2018-12-07 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2018-11-15 | 2018-12-07 | N |
| Provide or obtain dental services for each resident. | Health | 2018-11-15 | 2018-12-07 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2018-11-15 | 2018-12-07 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2018-11-15 | 2018-12-07 | N |
| Use approved construction type or materials. | Fire Safety | 2018-11-15 | 2018-12-07 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2018-11-15 | 2018-12-07 | 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 | 2018-11-15 | 2018-12-07 | N |
| Have horizontal exits used in accordance with safety requirements. | Fire Safety | 2018-11-15 | 2018-12-07 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2018-11-15 | 2018-12-07 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2018-11-15 | 2018-12-07 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2018-11-15 | 2018-12-07 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2018-11-15 | 2018-12-07 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2018-11-15 | 2018-12-07 | N |
