A list of the most recent deficiencies for Heritage Manor. 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? |
|---|---|---|---|---|
| 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 | 2023-04-10 | 2023-06-15 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-04-10 | 2023-06-15 | N |
| Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. | Health | 2023-04-10 | 2023-06-15 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-04-10 | 2023-06-15 | Y |
| 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 | 2023-04-10 | 2023-06-15 | Y |
| Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. | Fire Safety | 2023-05-22 | 2023-06-15 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2023-05-22 | 2023-06-15 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2023-05-22 | 2023-06-15 | N |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2021-11-08 | 2021-12-10 | N |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2021-11-08 | 2021-12-10 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2021-11-08 | 2021-12-10 | N |
| Respond appropriately to all alleged violations. | Health | 2021-11-08 | 2021-12-10 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2021-11-08 | 2021-12-10 | 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 | 2021-11-08 | 2021-12-10 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2021-11-08 | 2021-12-10 | N |
| Provide and implement an infection prevention and control program. | Health | 2021-11-08 | 2021-12-10 | N |
| Meet requirements for sections of health care facilities separated by fire resistive construction. | Fire Safety | 2021-11-03 | 2021-12-10 | 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 | 2021-11-03 | 2021-12-10 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2021-11-03 | 2021-12-10 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2021-11-03 | 2021-12-10 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2021-11-03 | 2021-12-10 | N |
| Provide activities to meet all resident's needs. | Health | 2019-06-17 | 2019-08-10 | N |
| Put firmly secured handrails on each side of hallways. | Health | 2019-06-17 | 2019-07-18 | N |
| Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. | Health | 2019-06-17 | 2019-07-10 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2019-06-17 | 2019-07-03 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2019-06-12 | 2019-06-28 | N |
| Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation. | Health | 2019-06-17 | 2019-06-25 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2019-06-12 | 2019-06-18 | N |
