Deficiency Records for Four Seasons Rehabilitation and Care
Updated as of April 01, 2024
A list of the most recent deficiencies for Four Seasons Rehabilitation and Care. 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? |
|---|---|---|---|---|
| Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | Health | 2024-01-29 | 2024-03-15 | N |
| Respond appropriately to all alleged violations. | Health | 2024-01-29 | 2024-03-15 | N |
| Assess the resident when there is a significant change in condition | Health | 2024-01-29 | 2024-03-15 | N |
| Ensure each resident receives an accurate assessment. | Health | 2024-01-29 | 2024-03-15 | N |
| Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. | Health | 2024-01-29 | 2024-03-15 | N |
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2024-01-29 | 2024-03-15 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2024-01-29 | 2024-03-15 | 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 | 2024-01-29 | 2024-03-15 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2024-01-29 | 2024-03-15 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2024-01-29 | 2024-03-15 | N |
| Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. | Health | 2024-01-29 | 2024-03-15 | 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 | 2024-01-29 | 2024-03-15 | N |
| Ensure that residents are free from significant medication errors. | Health | 2024-01-29 | 2024-03-15 | N |
| Provide timely, quality laboratory services/tests to meet the needs of residents. | Health | 2024-01-29 | 2024-03-15 | N |
| Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. | Health | 2024-01-29 | 2024-03-15 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2024-01-29 | 2024-03-15 | 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 | 2024-01-29 | 2024-03-15 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-10-11 | 2023-11-10 | Y |
| Provide enough food/fluids to maintain a resident's health. | Health | 2023-10-11 | 2023-11-10 | Y |
| Keep residents' personal and medical records private and confidential. | Health | 2023-10-11 | 2023-08-21 | 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 | 2023-05-24 | 2023-07-07 | Y |
| Ensure each resident receives an accurate assessment. | Health | 2023-05-24 | 2023-07-07 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2023-05-24 | 2023-07-07 | 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 | 2022-10-28 | 2022-11-21 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-10-28 | 2022-11-21 | N |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2022-10-28 | 2022-11-21 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2022-10-25 | 2022-11-21 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2022-10-25 | 2022-11-21 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2021-06-10 | 2021-07-10 | N |
| Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. | Health | 2021-06-10 | 2021-07-10 | N |
| Ensure that residents are free from significant medication errors. | Health | 2021-06-10 | 2021-07-10 | N |
| Provide timely, quality laboratory services/tests to meet the needs of residents. | Health | 2021-06-10 | 2021-07-10 | N |
| Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2019-04-10 | 2019-05-10 | N |
| Establish emergency prep training and testing. | Fire Safety | 2019-04-10 | 2019-05-10 | 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 | 2019-04-10 | 2019-05-10 | N |
| Have power receptacles that are properly grounded. | Fire Safety | 2019-04-10 | 2019-05-10 | N |
