Deficiency Records for Myrtle Point Rehabilitation and Care
Updated as of March 01, 2024
A list of the most recent deficiencies for Myrtle Point 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? |
|---|---|---|---|---|
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2023-08-02 | 2023-10-13 | 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 | 2023-08-02 | 2023-10-13 | 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 | 2023-08-02 | 2023-10-13 | Y |
| Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. | Health | 2023-08-02 | 2023-10-13 | Y |
| Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. | Health | 2023-08-02 | 2023-09-19 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2023-08-02 | 2023-09-19 | N |
| 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 | 2023-08-02 | 2023-09-19 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-08-02 | 2023-09-19 | N |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2023-08-02 | 2023-09-19 | 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 | 2023-08-02 | 2023-09-19 | N |
| Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. | Health | 2023-08-02 | 2023-09-19 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-08-02 | 2023-09-19 | N |
| Have an agreement with at least one or more hospitals certified by Medicare or Medicaid to make sure residents can be moved quickly to the hospital when they need medical care. | Health | 2023-08-02 | 2023-09-19 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-08-02 | 2023-09-19 | N |
| Implement a program that monitors antibiotic use. | Health | 2023-08-02 | 2023-09-19 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2023-08-02 | 2023-09-19 | N |
| Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. | Health | 2023-08-02 | 2023-09-19 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-08-02 | 2023-09-19 | Y |
| Not hire anyone with a finding of abuse, neglect, exploitation, or theft. | Health | 2023-08-02 | 2023-09-19 | Y |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2023-08-02 | 2023-09-19 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2023-08-02 | 2023-09-19 | Y |
| Respond appropriately to all alleged violations. | Health | 2023-08-02 | 2023-09-19 | Y |
| Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. | Health | 2023-08-02 | 2023-09-19 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-08-02 | 2023-09-19 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-08-02 | 2023-09-19 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-08-02 | 2023-09-19 | Y |
| Provide enough food/fluids to maintain a resident's health. | Health | 2023-08-02 | 2023-09-19 | Y |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-08-02 | 2023-09-19 | Y |
| Ensure that the resident and his/her doctor meet face-to-face at all required visits. | Health | 2023-08-02 | 2023-09-19 | 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 | 2023-08-02 | 2023-09-19 | Y |
| Observe each nurse aide's job performance and give regular training. | Health | 2023-08-02 | 2023-09-19 | Y |
| Administer the facility in a manner that enables it to use its resources effectively and efficiently. | Health | 2023-08-02 | 2023-09-19 | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2023-08-02 | 2023-09-19 | Y |
| Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. | Health | 2023-08-02 | 2023-09-19 | Y |
| Have a plan that describes the process for conducting QAPI and QAA activities. | Health | 2023-08-02 | 2023-09-19 | Y |
| Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. | Health | 2023-08-02 | 2023-09-19 | Y |
| Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | Health | 2023-08-02 | 2023-09-19 | Y |
| Develop, implement, and/or maintain an effective training program for all new and existing staff members. | Health | 2023-08-02 | 2023-09-19 | Y |
| Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. | Health | 2023-08-02 | 2023-09-19 | Y |
| Conduct testing and exercise requirements. | Fire Safety | 2023-07-25 | 2023-08-31 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-07-25 | 2023-08-31 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2023-07-25 | 2023-08-31 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2023-07-25 | 2023-08-31 | N |
| Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. | Health | 2022-09-10 | 2022-11-10 | N |
| Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. | Health | 2022-09-10 | 2022-11-10 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-09-10 | 2022-11-10 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2022-09-10 | 2022-11-10 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-09-10 | 2022-11-10 | N |
| Provide activities to meet all resident's needs. | Health | 2022-09-10 | 2022-11-10 | 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 | 2022-09-10 | 2022-11-10 | N |
| Ensure that the resident and his/her doctor meet face-to-face at all required visits. | Health | 2022-09-10 | 2022-11-10 | N |
| Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. | Health | 2022-09-10 | 2022-11-10 | N |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2022-09-10 | 2022-11-10 | N |
| Install noncombustible or limited-combustible interior walls. | Fire Safety | 2022-09-12 | 2022-10-30 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2022-09-12 | 2022-10-30 | N |
| Post nurse staffing information every day. | Health | 2018-10-31 | 2019-02-14 | N |
| Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | Health | 2018-10-31 | 2018-12-20 | N |
| 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 | 2018-10-31 | 2018-12-20 | N |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2018-10-31 | 2018-12-20 | N |
| Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. | Health | 2018-10-31 | 2018-12-20 | 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 | 2018-10-31 | 2018-12-20 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2018-10-31 | 2018-12-20 | N |
| Provide activities to meet all resident's needs. | Health | 2018-10-31 | 2018-12-20 | 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 | 2018-10-31 | 2018-12-20 | N |
| Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. | Health | 2018-10-31 | 2018-12-20 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2018-10-31 | 2018-12-20 | N |
| Develop Emergency Preparedness policies and procedures. | Fire Safety | 2018-10-24 | 2018-12-18 | N |
| Conduct testing and exercise requirements. | Fire Safety | 2018-10-24 | 2018-12-18 | N |
| Install resident room doors of proper design and width. | Fire Safety | 2018-10-24 | 2018-12-18 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2018-10-24 | 2018-12-18 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2018-10-24 | 2018-12-18 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2018-10-24 | 2018-12-18 | N |