Deficiency Records for Vancrest Health Care Center of Eaton
Updated as of April 01, 2024
A list of the most recent deficiencies for Vancrest Health Care Center of Eaton. 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? |
|---|---|---|---|---|
| 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 | 2023-01-12 | 2023-03-20 | 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 | 2023-01-12 | 2023-03-20 | 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 | 2023-01-10 | 2023-03-20 | 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 | 2023-01-10 | 2023-03-20 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2023-01-10 | 2023-03-20 | 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 | 2023-01-10 | 2023-03-20 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2023-01-10 | 2023-03-20 | N |
| Have a fire alarm with audible and visual signals that transmits the alarm automatically to notify emergency forces in event of fire. | Fire Safety | 2023-01-10 | 2023-03-20 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2023-01-10 | 2023-03-20 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2023-01-10 | 2023-03-20 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-01-10 | 2023-03-20 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2023-01-10 | 2023-03-20 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2023-01-10 | 2023-03-20 | N |
| Provide a written emergency evacuation plan. | Fire Safety | 2023-01-10 | 2023-03-20 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2023-01-10 | 2023-03-20 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2023-01-10 | 2023-03-20 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2023-01-10 | 2023-03-20 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2023-01-10 | 2023-03-20 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2023-01-10 | 2023-03-20 | N |
| Provide timely, quality laboratory services/tests to meet the needs of residents. | Health | 2022-04-15 | 2022-05-17 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-02-04 | 2022-02-26 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2021-12-27 | 2022-02-26 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2019-10-03 | 2020-01-03 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2019-10-03 | 2020-01-03 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2019-10-01 | 2020-01-03 | N |
| Provide a written emergency evacuation plan. | Fire Safety | 2019-10-01 | 2020-01-03 | N |
| Have restrictions on the use of portable space heaters. | Fire Safety | 2019-10-01 | 2020-01-03 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2019-10-01 | 2020-01-03 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2019-10-01 | 2020-01-03 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2018-08-23 | 2018-09-15 | N |
| Develop Emergency Preparedness policies and procedures. | Fire Safety | 2018-08-23 | 2018-09-15 | N |
| Establish roles under a Waiver declared by secretary. | Fire Safety | 2018-08-23 | 2018-09-15 | N |
| Provide emergency officials' contact information. | Fire Safety | 2018-08-23 | 2018-09-15 | N |
| Conduct testing and exercise requirements. | Fire Safety | 2018-08-23 | 2018-09-15 | 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 | 2018-08-23 | 2018-09-15 | N |
