CONTACT INFORMATION REVIEWS & MORE DATA
Deficiency Records for Edenbrook South
View the most recent health deficiencies and inspection results for Edenbrook South. Stay informed about quality of care issues.
View the most recent health deficiencies and inspection results for Edenbrook South. Stay informed about quality of care issues.
| Deficiency | Type of Deficiency | Deficiency Date | Date Corrected | Resulted from a Complaint? |
|---|---|---|---|---|
| Have stairways and smokeproof enclosures used as exits that meet safety requirements. | Fire Safety | 2026-02-11 | 2026-04-07 | 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 | 2026-02-11 | 2026-04-07 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2026-02-11 | 2026-04-07 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2026-02-11 | 2026-04-07 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2026-02-11 | 2026-04-07 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2026-02-11 | 2026-04-07 | N |
| Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | Health | 2026-02-11 | 2026-03-31 | N |
| Ensure each resident receives an accurate assessment. | Health | 2026-02-11 | 2026-03-31 | N |
| Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. | Health | 2026-02-11 | 2026-03-31 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2026-02-11 | 2026-03-31 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2026-02-11 | 2026-03-31 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2026-02-11 | 2026-03-31 | 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 | 2026-02-11 | 2026-03-31 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2026-02-11 | 2026-03-31 | 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 | 2026-02-11 | 2026-03-31 | N |
| Observe each nurse aide's job performance and give regular training. | Health | 2026-02-11 | 2026-03-31 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2026-02-11 | 2026-03-31 | 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 | 2026-02-11 | 2026-03-31 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2026-02-11 | 2026-03-31 | 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 | 2026-02-11 | 2026-03-31 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2026-02-11 | 2026-03-31 | N |
| Dispose of garbage and refuse properly. | Health | 2026-02-11 | 2026-03-31 | N |
| Provide and implement an infection prevention and control program. | Health | 2026-02-11 | 2026-03-31 | 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 | 2026-02-11 | 2026-03-31 | N |
| Keep residents' personal and medical records private and confidential. | Health | 2026-02-11 | 2026-03-31 | 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 | 2026-02-11 | 2026-03-31 | N |
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2026-02-11 | 2026-03-31 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2025-06-04 | 2025-07-15 | Y |
| Provide enough food/fluids to maintain a resident's health. | Health | 2025-03-04 | 2025-03-25 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2025-03-04 | 2025-03-25 | Y |
| Ensure each resident receives an accurate assessment. | Health | 2025-01-24 | 2025-03-12 | N |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2025-01-24 | 2025-03-12 | 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 | 2025-01-24 | 2025-03-12 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2025-01-24 | 2025-03-12 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2025-01-24 | 2025-03-12 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2025-01-24 | 2025-03-12 | 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 | 2025-01-24 | 2025-03-12 | N |
| Provide and implement an infection prevention and control program. | Health | 2025-01-24 | 2025-03-12 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2025-01-24 | 2025-03-12 | 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 | 2025-01-24 | 2025-03-12 | 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 | 2025-01-24 | 2025-03-12 | 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 | 2025-01-24 | 2025-03-12 | 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 | 2025-01-24 | 2025-03-12 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2025-01-24 | 2025-03-12 | N |
| Meet requirements for the use of electrical equipment. | Fire Safety | 2025-01-24 | 2025-02-10 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2025-01-24 | 2025-02-10 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2025-01-24 | 2025-02-10 | N |
| Have properly installed hallway dispensers for alcohol-based hand rub. | Fire Safety | 2025-01-24 | 2025-02-10 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2025-01-24 | 2025-02-10 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2025-01-24 | 2025-02-10 | 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 | 2025-01-24 | 2025-02-10 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2024-09-12 | 2024-10-22 | Y |
| Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. | Health | 2024-09-12 | 2024-10-22 | Y |
| 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 | 2024-09-12 | 2024-10-22 | Y |
| 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 | 2024-08-06 | 2024-09-10 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2024-05-22 | 2024-07-02 | Y |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2024-05-22 | 2024-07-02 | Y |
| Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | Health | 2024-05-22 | 2024-07-02 | Y |
| Obtain a doctor's order to admit a resident and ensure the resident is under a doctor's care. | Health | 2024-05-22 | 2024-07-02 | Y |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2024-05-22 | 2024-07-02 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2024-05-02 | 2024-04-26 | Y |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2024-02-16 | 2024-04-02 | 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 | 2024-02-16 | 2024-04-02 | N |
| Post nurse staffing information every day. | Health | 2024-02-16 | 2024-04-02 | 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 | 2024-02-16 | 2024-04-02 | Y |
| Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | Health | 2024-02-16 | 2024-04-02 | 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 | 2024-02-16 | 2024-04-02 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2024-02-16 | 2024-04-02 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2024-02-16 | 2024-04-02 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2024-02-16 | 2024-04-02 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2024-02-16 | 2024-04-02 | 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 | 2024-02-16 | 2024-04-02 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2024-02-16 | 2024-04-02 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2024-02-16 | 2024-04-02 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2024-02-16 | 2024-03-27 | N |
| Have stairways and smokeproof enclosures used as exits that meet safety requirements. | Fire Safety | 2024-02-16 | 2024-03-27 | 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 | 2024-02-16 | 2024-03-27 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2024-02-16 | 2024-03-27 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2024-02-16 | 2024-03-27 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2024-02-16 | 2024-03-27 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-11-08 | 2023-11-17 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-10-13 | 2023-11-09 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-09-20 | 2023-10-26 | Y |
| Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | Health | 2023-09-20 | 2023-10-26 | Y |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-07-13 | 2023-08-01 | Y |
| 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 | 2023-07-13 | 2023-08-01 | Y |
| 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 | 2023-06-22 | 2023-07-18 | Y |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-06-22 | 2023-07-18 | Y |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2025-12-23 | Not Fixed | Y |