A list of the most recent deficiencies for Wagoner Health and Rehab. 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? |
|---|---|---|---|---|
| Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. | Health | 2023-12-29 | 2024-02-15 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-12-29 | 2024-02-15 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2023-12-29 | 2024-02-15 | 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 | 2023-12-29 | 2024-02-15 | 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 | 2023-12-29 | 2024-02-15 | N |
| Provide timely, quality laboratory services/tests to meet the needs of residents. | Health | 2023-12-29 | 2024-02-15 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-12-29 | 2024-02-15 | N |
| Have a plan that describes the process for conducting QAPI and QAA activities. | Health | 2023-12-29 | 2024-02-15 | N |
| Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2023-04-10 | 2023-06-06 | N |
| Conduct risk assessment and an All-Hazards approach. | Fire Safety | 2023-04-10 | 2023-06-06 | N |
| Establish policies and procedures for volunteers. | Fire Safety | 2023-04-10 | 2023-06-06 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-04-10 | 2023-06-06 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2023-04-10 | 2023-06-06 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2023-04-10 | 2023-06-06 | 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 | 2023-01-17 | 2023-05-25 | N |
| Provide timely, quality laboratory services/tests to meet the needs of residents. | Health | 2023-01-17 | 2023-05-23 | N |
| Encode each resident?s assessment data and transmit these data to the State within 7 days of assessment. | Health | 2023-01-17 | 2023-05-15 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2023-04-10 | 2023-05-15 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2023-04-10 | 2023-05-15 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2023-04-10 | 2023-05-15 | N |
| Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. | Health | 2023-01-17 | 2023-05-10 | 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 | 2023-01-17 | 2023-05-10 | N |
| Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. | Health | 2023-01-17 | 2023-05-10 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2023-01-17 | 2023-05-10 | 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 | 2023-01-17 | 2023-05-10 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2023-01-17 | 2023-05-10 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-01-17 | 2023-03-28 | N |
| Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident?s advance directives. | Health | 2023-01-17 | 2023-03-15 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2023-01-17 | 2023-02-10 | N |
| Provide and implement an infection prevention and control program. | Health | 2021-08-20 | 2021-09-30 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2019-08-28 | 2019-10-15 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2019-09-04 | 2019-10-12 | N |
| Provide activities to meet all resident's needs. | Health | 2019-09-04 | 2019-10-11 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2019-09-04 | 2019-10-11 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2019-09-04 | 2019-10-11 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2019-09-04 | 2019-10-11 | N |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2019-09-04 | 2019-10-11 | 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 | 2019-09-04 | 2019-10-11 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2019-09-04 | 2019-10-11 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2019-08-28 | 2019-10-11 | N |
| Properly provide smoke detection systems in areas open to corridors. | Fire Safety | 2019-08-28 | 2019-10-11 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2019-08-28 | 2019-10-11 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2019-08-28 | 2019-10-11 | 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 | 2019-09-04 | 2019-10-01 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2019-09-04 | 2019-10-01 | 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 | 2019-08-28 | 2019-10-01 | N |
| Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2018-10-03 | 2018-11-13 | N |
| Establish emergency prep training and testing. | Fire Safety | 2018-10-03 | 2018-11-13 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2018-10-03 | 2018-11-12 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2018-10-03 | 2018-11-11 | N |
| Have properly located and lighted "Exit" signs. | Fire Safety | 2018-10-03 | 2018-11-11 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2018-10-03 | 2018-11-11 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2018-10-03 | 2018-11-10 | N |
| Have power receptacles that are properly grounded. | Fire Safety | 2018-10-03 | 2018-11-10 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2018-10-03 | 2018-11-10 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2018-10-03 | 2018-11-01 | N |
