A list of the most recent deficiencies for Cheltenham Nursing and Rehab C. 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? |
|---|---|---|---|---|
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2024-01-18 | 2024-02-21 | Y |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2024-01-18 | 2024-02-21 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2024-01-18 | 2024-02-21 | Y |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2024-01-18 | 2024-02-21 | Y |
| Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. | Health | 2024-01-18 | 2024-02-21 | Y |
| Administer the facility in a manner that enables it to use its resources effectively and efficiently. | Health | 2024-01-18 | 2024-02-21 | Y |
| Provide and implement an infection prevention and control program. | Health | 2024-01-18 | 2024-02-21 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2023-10-23 | 2023-11-27 | N |
| Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. | Health | 2023-10-23 | 2023-11-27 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2023-10-23 | 2023-11-27 | 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 | 2023-10-23 | 2023-11-27 | N |
| Respond appropriately to all alleged violations. | Health | 2023-10-23 | 2023-11-27 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-10-23 | 2023-11-27 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-10-23 | 2023-11-27 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-10-23 | 2023-11-27 | N |
| Assist a resident in gaining access to vision and hearing services. | Health | 2023-10-23 | 2023-11-27 | 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 | 2023-10-23 | 2023-11-27 | N |
| Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. | Health | 2023-10-23 | 2023-11-27 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-10-23 | 2023-11-27 | N |
| Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. | Health | 2023-10-23 | 2023-11-27 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2023-10-23 | 2023-11-27 | N |
| Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. | Health | 2023-10-23 | 2023-11-27 | 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 | 2023-10-23 | 2023-11-27 | N |
| Dispose of garbage and refuse properly. | Health | 2023-10-23 | 2023-11-27 | N |
| Administer the facility in a manner that enables it to use its resources effectively and efficiently. | Health | 2023-10-23 | 2023-11-27 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-10-23 | 2023-11-27 | N |
| Develop, implement, and/or maintain an effective training program for all new and existing staff members. | Health | 2023-10-23 | 2023-11-27 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2023-10-23 | 2023-11-27 | Y |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2023-11-08 | 2023-11-27 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2023-11-08 | 2023-11-27 | N |
| Ensure that residents are free from significant medication errors. | Health | 2023-10-23 | 2023-11-17 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-10-23 | 2023-10-23 | 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 | 2023-04-12 | 2023-05-12 | N |
| Properly install and monitor supervisory attachments on automatic sprinkler systems. | Fire Safety | 2023-04-12 | 2023-05-12 | N |
| Have power receptacles that are properly grounded. | Fire Safety | 2023-04-12 | 2023-05-12 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-03-31 | 2023-05-08 | 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 | 2023-03-31 | 2023-05-08 | 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 | 2023-03-31 | 2023-05-08 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2023-03-31 | 2023-05-08 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-03-31 | 2023-05-08 | N |
| Provide safe, appropriate pain management for a resident who requires such services. | Health | 2023-03-31 | 2023-05-08 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2023-03-31 | 2023-05-08 | 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 | 2023-03-31 | 2023-05-08 | N |
| Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. | Health | 2023-03-31 | 2023-05-08 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-03-31 | 2023-05-08 | Y |
| Ensure each resident must receive and the facility must provide necessary behavioral health care and services. | Health | 2023-03-31 | 2023-05-08 | Y |
| Administer the facility in a manner that enables it to use its resources effectively and efficiently. | Health | 2023-03-31 | 2023-05-08 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-02-22 | 2023-03-15 | Y |
| Administer the facility in a manner that enables it to use its resources effectively and efficiently. | Health | 2023-02-22 | 2023-03-15 | Y |
| Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. | Health | 2022-12-13 | 2023-01-09 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-07-27 | 2022-08-22 | Y |
| Use approved construction type or materials. | Fire Safety | 2022-05-16 | 2022-07-05 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2022-05-16 | 2022-07-05 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2022-05-16 | 2022-07-05 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-05-16 | 2022-07-05 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2022-05-16 | 2022-07-05 | N |
| Install properly constructed and protected linen or trash chutes. | Fire Safety | 2022-05-16 | 2022-07-05 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2022-05-16 | 2022-07-05 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2022-05-16 | 2022-07-05 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2022-05-16 | 2022-07-05 | 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 | 2022-05-13 | 2022-06-20 | N |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2022-05-13 | 2022-06-20 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-05-13 | 2022-06-20 | N |
| Dispose of garbage and refuse properly. | Health | 2022-05-13 | 2022-06-20 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2021-08-04 | 2021-09-06 | Y |
| Administer the facility in a manner that enables it to use its resources effectively and efficiently. | Health | 2021-07-19 | 2021-08-05 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-07-19 | 2021-07-27 | Y |
