A list of the most recent deficiencies for Baldwin Health Center. 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? |
|---|---|---|---|---|
| Keep residents' personal and medical records private and confidential. | Health | 2024-01-19 | 2024-02-20 | 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 | 2024-01-19 | 2024-02-20 | 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 | 2024-01-19 | 2024-02-20 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2024-01-19 | 2024-02-20 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2024-01-19 | 2024-02-20 | 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 | 2024-01-19 | 2024-02-20 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2024-01-19 | 2024-02-20 | N |
| Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector. | Fire Safety | 2024-01-24 | 2024-02-09 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2024-01-24 | 2024-02-09 | N |
| Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. | Health | 2023-12-13 | 2024-01-05 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-12-13 | 2024-01-05 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-11-09 | 2023-12-17 | Y |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2023-11-09 | 2023-12-17 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2023-11-09 | 2023-12-17 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-11-09 | 2023-12-17 | Y |
| Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | Health | 2023-11-09 | 2023-12-17 | 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 | 2023-11-09 | 2023-12-17 | Y |
| Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation. | Health | 2023-11-09 | 2023-12-17 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2023-08-01 | 2023-08-25 | 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 | 2023-08-01 | 2023-08-25 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-08-01 | 2023-08-25 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-08-01 | 2023-08-25 | N |
| Ensure that residents are free from significant medication errors. | Health | 2023-08-01 | 2023-08-25 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-08-01 | 2023-08-25 | N |
| Respond appropriately to all alleged violations. | Health | 2023-08-01 | 2023-08-25 | 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 | 2023-07-11 | 2023-07-31 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-07-11 | 2023-07-31 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2023-07-11 | 2023-07-31 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2023-07-11 | 2023-07-31 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2023-07-11 | 2023-07-31 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-06-02 | 2023-06-23 | Y |
| Protect each resident from the wrongful use of the resident's belongings or money. | Health | 2023-04-21 | 2023-05-17 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2023-04-21 | 2023-05-17 | Y |
| Provide appropriate foot care. | Health | 2023-04-21 | 2023-05-17 | 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 | 2023-04-21 | 2023-05-17 | 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 | 2023-04-21 | 2023-05-17 | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2023-04-21 | 2023-05-17 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-03-10 | 2023-03-21 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2022-08-05 | 2022-09-07 | N |
| Post a list of names, addresses, and telephone numbers of all pertinent State agencies and advocacy groups and a statement that the resident may file a complaint with the State Survey Agency. | Health | 2022-08-05 | 2022-09-07 | 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 | 2022-08-05 | 2022-09-07 | 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 | 2022-08-05 | 2022-09-07 | N |
| Not hire anyone with a finding of abuse, neglect, exploitation, or theft. | Health | 2022-08-05 | 2022-09-07 | N |
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2022-08-05 | 2022-09-07 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-08-05 | 2022-09-07 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-08-05 | 2022-09-07 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2022-08-05 | 2022-09-07 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2022-08-05 | 2022-09-07 | 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 | 2022-08-05 | 2022-09-07 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2022-08-05 | 2022-09-07 | N |
| Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. | Health | 2022-08-05 | 2022-09-07 | 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 | 2022-08-05 | 2022-09-07 | N |
| Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. | Health | 2022-08-05 | 2022-09-07 | N |
| Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. | Health | 2022-08-05 | 2022-09-07 | N |
| Ensure meals and snacks are served at times in accordance with resident?s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. | Health | 2022-08-05 | 2022-09-07 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-08-05 | 2022-09-07 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2022-08-05 | 2022-09-07 | N |
| Have a plan that describes the process for conducting QAPI and QAA activities. | Health | 2022-08-05 | 2022-09-07 | N |
| Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. | Health | 2022-08-05 | 2022-09-07 | N |
| Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | Health | 2022-08-05 | 2022-09-07 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-08-05 | 2022-09-07 | N |
| Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation. | Health | 2022-08-05 | 2022-09-07 | N |
| Meet other general requirements. | Fire Safety | 2022-08-04 | 2022-08-17 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-08-04 | 2022-08-17 | N |
| Meet requirements for the installation and maintenance of electrical systems. | Fire Safety | 2022-08-04 | 2022-08-17 | N |
| Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death. | Health | 2022-07-05 | 2022-07-22 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2022-07-05 | 2022-07-22 | Y |
| Keep residents' personal and medical records private and confidential. | Health | 2022-01-11 | 2022-02-08 | 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 | 2022-01-11 | 2022-02-08 | 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 | 2022-01-11 | 2022-02-08 | Y |
| Provide and implement an infection prevention and control program. | Health | 2021-06-04 | 2021-07-21 | 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 | 2021-06-04 | 2021-07-21 | Y |
| Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. | Health | 2021-06-04 | 2021-07-21 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2021-06-04 | 2021-07-21 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2021-06-04 | 2021-07-21 | Y |
| Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | Health | 2021-06-04 | 2021-07-21 | Y |
| Make sure that a working call system is available in each resident's bathroom and bathing area. | Health | 2021-06-04 | 2021-07-21 | 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 | 2023-06-14 | Not Fixed | 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 | 2023-06-14 | Not Fixed | Y |
| Provide and implement an infection prevention and control program. | Health | 2023-06-14 | Not Fixed | Y |
