A list of the most recent deficiencies for Vancrest of New Carlisle. 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? |
|---|---|---|---|---|
| Reasonably accommodate the needs and preferences of each resident. | Health | 2023-02-16 | 2023-03-31 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2023-02-16 | 2023-03-31 | N |
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2023-02-16 | 2023-03-31 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-02-16 | 2023-03-31 | 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 | 2023-02-16 | 2023-03-31 | N |
| Inform each resident of his or her visitation rights and ensure that all visitors enjoy equal visitation privileges. | Health | 2023-02-16 | 2023-03-31 | 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 | 2023-02-16 | 2023-03-31 | N |
| Have horizontal exits used in accordance with safety requirements. | Fire Safety | 2023-02-16 | 2023-03-31 | N |
| Install proper backup exit lighting. | Fire Safety | 2023-02-16 | 2023-03-31 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-02-16 | 2023-03-31 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2023-02-16 | 2023-03-31 | N |
| Have a battery powered remote alarm panel in a location accessible by operating personnel. | Fire Safety | 2023-02-16 | 2023-03-31 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-12-14 | 2023-01-06 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2022-12-14 | 2023-01-06 | Y |
| Ensure staff are vaccinated for COVID-19 | Health | 2022-04-04 | 2022-05-30 | Y |
| Have properly located and lighted "Exit" signs. | Fire Safety | 2021-05-12 | 2021-08-06 | N |
| Have an enclosure around a vertical opening shaft. | Fire Safety | 2021-05-12 | 2021-08-06 | 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 | 2021-05-12 | 2021-08-06 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2021-05-12 | 2021-08-06 | N |
| Follow proper procedures when the fire alarm was out of service for more than 4 hours. | Fire Safety | 2021-05-12 | 2021-08-06 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2021-05-12 | 2021-08-06 | N |
| Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2021-05-12 | 2021-08-06 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2021-05-12 | 2021-08-06 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2021-05-12 | 2021-08-06 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2021-05-12 | 2021-08-06 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2021-05-12 | 2021-08-06 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2021-05-12 | 2021-08-06 | N |
| Have restrictions on the use of highly flammable decorations. | Fire Safety | 2021-05-12 | 2021-08-06 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2021-05-12 | 2021-08-06 | N |
| Ensure equipment listed for use in oxygen-enriched atmospheres are correctly labeled. | Fire Safety | 2021-05-12 | 2021-08-06 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2019-06-13 | 2019-07-26 | N |
| Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | Health | 2019-06-13 | 2019-07-26 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2019-06-13 | 2019-07-26 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2019-06-13 | 2019-07-26 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2019-06-13 | 2019-07-26 | N |
| Provide or get specialized rehabilitative services as required for a resident. | Health | 2019-06-13 | 2019-07-26 | N |
| Provide and implement an infection prevention and control program. | Health | 2019-06-13 | 2019-07-26 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2019-06-12 | 2019-07-26 | 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 | 2019-06-12 | 2019-07-26 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2019-06-12 | 2019-07-26 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2019-06-12 | 2019-07-26 | N |
| Provide a written emergency evacuation plan. | Fire Safety | 2019-06-12 | 2019-07-26 | N |
