A list of the most recent deficiencies for Tekakwitha Living 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? |
|---|---|---|---|---|
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-06-01 | 2023-07-16 | 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 | 2023-06-01 | 2023-07-16 | N |
| Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. | Health | 2023-06-01 | 2023-07-16 | N |
| Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. | Health | 2023-06-01 | 2023-07-16 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-06-01 | 2023-07-16 | 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 | 2022-01-27 | 2022-02-25 | N |
| Notify the resident or the resident?s representative in writing how long the nursing home will hold the resident?s bed in cases of transfer to a hospital or therapeutic leave. | Health | 2022-01-27 | 2022-02-25 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-01-27 | 2022-02-25 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-01-27 | 2022-02-25 | N |
| Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2022-01-27 | 2022-02-25 | N |
| Develop Emergency Preparedness policies and procedures. | Fire Safety | 2022-01-27 | 2022-02-25 | 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 | 2019-12-11 | 2020-01-10 | N |
| Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | Health | 2019-12-11 | 2020-01-10 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2019-12-11 | 2020-01-10 | 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 | 2019-12-11 | 2020-01-10 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2019-12-11 | 2020-01-10 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2019-12-11 | 2020-01-10 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2019-12-11 | 2020-01-10 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2019-12-11 | 2020-01-10 | 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 | 2019-12-10 | 2020-01-10 | N |
| Install resident room doors of proper design and width. | Fire Safety | 2019-12-10 | 2020-01-10 | N |
| Conform to length requirements for dead end corridors. | Fire Safety | 2019-12-10 | 2020-01-10 | N |
| Have exits that are accessible at all times. | Fire Safety | 2019-12-10 | 2020-01-10 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2019-12-10 | 2020-01-10 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2019-12-10 | 2020-01-10 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2019-12-10 | 2020-01-10 | N |
| Ensure that testing and maintenance of electrical equipment is performed. | Fire Safety | 2019-12-10 | 2020-01-10 | N |
