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Deficiency Records for St Andrews Operator, LLC
View the most recent health deficiencies and inspection results for St Andrews Operator, LLC. Stay informed about quality of care issues.
View the most recent health deficiencies and inspection results for St Andrews Operator, LLC. Stay informed about quality of care issues.
| Deficiency | Type of Deficiency | Deficiency Date | Date Corrected | Resulted from a Complaint? |
|---|---|---|---|---|
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2025-07-17 | 2025-09-19 | 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 | 2025-07-17 | 2025-09-19 | 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 | 2025-07-17 | 2025-09-19 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2025-07-17 | 2025-09-19 | N |
| Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. | Health | 2025-07-17 | 2025-09-19 | N |
| Ensure each resident receives an accurate assessment. | Health | 2025-07-17 | 2025-08-15 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2025-07-17 | 2025-08-15 | N |
| Provide and implement an infection prevention and control program. | Health | 2025-07-17 | 2025-08-15 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2025-04-29 | 2025-05-30 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2025-04-29 | 2025-05-30 | Y |
| Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. | Health | 2025-04-29 | 2025-05-30 | Y |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2025-04-29 | 2025-05-30 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2025-04-29 | 2025-05-30 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2025-04-29 | 2025-05-30 | 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 | 2024-01-24 | 2024-02-16 | N |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2024-01-24 | 2024-02-16 | N |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2024-01-24 | 2024-02-16 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2024-01-24 | 2024-02-16 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2024-01-24 | 2024-02-16 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2024-01-24 | 2024-02-16 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2024-01-24 | 2024-02-16 | N |
| Provide and implement an infection prevention and control program. | Health | 2024-01-24 | 2024-02-16 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2024-01-24 | 2024-02-09 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2023-07-12 | 2023-08-15 | Y |
| Keep residents' personal and medical records private and confidential. | Health | 2021-10-28 | 2022-01-11 | 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 | 2021-10-28 | 2022-01-11 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2021-10-28 | 2022-01-11 | N |
| Make sure that a working call system is available in each resident's bathroom and bathing area. | Health | 2021-10-28 | 2021-12-17 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2021-10-28 | 2021-12-17 | N |
| Ensure that residents are free from significant medication errors. | Health | 2021-10-28 | 2021-12-17 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2021-10-28 | 2021-12-17 | 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 | 2021-10-28 | 2021-12-17 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2021-10-28 | 2021-12-17 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2021-10-28 | 2021-12-17 | N |
| PASARR screening for Mental disorders or Intellectual Disabilities | Health | 2021-10-28 | 2021-12-17 | N |
| Respond appropriately to all alleged violations. | Health | 2021-10-28 | 2021-12-17 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2021-10-28 | 2021-12-17 | N |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2021-10-28 | 2021-12-17 | 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 | 2021-10-28 | 2021-12-17 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2021-10-28 | 2021-12-03 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-10-28 | 2021-06-30 | N |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2021-10-28 | 2021-06-30 | N |