A list of the most recent deficiencies for The Lutheran Home at Topton. 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? |
|---|---|---|---|---|
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-11-28 | 2024-01-06 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2023-11-15 | 2024-01-04 | N |
| Ensure each resident receives an accurate assessment. | Health | 2023-11-15 | 2024-01-04 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-11-15 | 2024-01-04 | 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 | 2023-11-15 | 2024-01-04 | 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 | 2023-11-15 | 2024-01-04 | N |
| Provide special eating equipment and utensils for residents who need them and appropriate assistance. | Health | 2023-11-15 | 2024-01-04 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-08-21 | 2023-09-27 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2023-08-21 | 2023-09-27 | Y |
| Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | Health | 2023-04-21 | 2023-06-14 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-12-21 | 2023-02-07 | 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 | 2022-12-21 | 2023-02-07 | 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 | 2022-12-21 | 2023-02-07 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-12-21 | 2023-02-07 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2022-12-07 | 2023-02-05 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2022-12-07 | 2023-02-05 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-12-07 | 2023-02-05 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2022-12-07 | 2023-02-05 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2022-12-07 | 2023-02-05 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2021-12-30 | 2022-02-28 | 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 | 2021-12-30 | 2022-02-28 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-12-30 | 2022-02-28 | N |
| Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. | Health | 2021-12-30 | 2022-02-28 | N |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2021-12-30 | 2022-02-28 | N |
| Meet requirements for sections of health care facilities separated by fire resistive construction. | Fire Safety | 2021-12-16 | 2022-02-18 | N |
| Use approved construction type or materials. | Fire Safety | 2021-12-16 | 2022-02-05 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2021-12-16 | 2022-02-05 | N |
| Have stairways and smokeproof enclosures used as exits that meet safety requirements. | Fire Safety | 2021-12-16 | 2022-02-05 | 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 | 2021-12-16 | 2022-02-05 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2021-12-16 | 2022-02-05 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2021-12-16 | 2022-02-05 | N |
| Have properly sized and located compartments to protect residents from smoke. | Fire Safety | 2021-12-16 | 2022-02-05 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2021-12-16 | 2022-02-05 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2021-12-16 | 2022-02-05 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2021-12-16 | 2022-02-05 | N |
