A list of the most recent deficiencies for Orchard Manor, Inc. 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? |
|---|---|---|---|---|
| Establish policies and procedures for sheltering. | Fire Safety | 2023-11-08 | 2024-01-17 | N |
| Conduct testing and exercise requirements. | Fire Safety | 2023-11-08 | 2024-01-17 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-11-09 | 2023-11-27 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2023-11-08 | 2023-11-27 | N |
| Have power receptacles that are properly grounded. | Fire Safety | 2023-11-08 | 2023-11-27 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2023-11-08 | 2023-11-27 | 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 | 2023-01-26 | 2023-03-20 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2023-01-26 | 2023-03-20 | 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 | 2023-01-26 | 2023-03-20 | 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 | 2023-01-26 | 2023-03-20 | 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 | 2023-01-26 | 2023-03-06 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2023-01-26 | 2023-03-06 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-01-26 | 2023-03-06 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2023-01-26 | 2023-03-06 | N |
| Provide properly sized and located linen or trash receptacles. | Fire Safety | 2023-01-26 | 2023-03-06 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-01-26 | 2023-03-06 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2023-01-26 | 2023-03-06 | N |
| Conduct risk assessment and an All-Hazards approach. | Fire Safety | 2022-01-13 | 2022-03-07 | N |
| Meet other general requirements. | Fire Safety | 2022-01-13 | 2022-03-07 | N |
| Install a two-hour-resistant firewall separation. | Fire Safety | 2022-01-13 | 2022-03-07 | N |
| Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements. | Fire Safety | 2022-01-13 | 2022-03-07 | N |
| Have properly located and lighted "Exit" signs. | Fire Safety | 2022-01-13 | 2022-03-07 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2022-01-13 | 2022-03-07 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2022-01-13 | 2022-03-07 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2022-01-13 | 2022-03-07 | N |
| Meet requirements for the installation and maintenance of electrical systems. | Fire Safety | 2022-01-13 | 2022-03-07 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-09-26 | Not Fixed | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2023-07-06 | Not Fixed | Y |
