Deficiency Records for Ballard Center

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Updated as of March 01, 2024

A list of the most recent deficiencies for Ballard 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?
Conduct testing and exercise requirements. Fire Safety 2023-09-14 2023-12-14 N
Provide properly protected cooking facilities. Fire Safety 2023-09-14 2023-12-14 N
Have approved installation, maintenance and testing program for fire alarm systems. Fire Safety 2023-09-14 2023-12-14 N
Inspect, test, and maintain automatic sprinkler systems. Fire Safety 2023-09-14 2023-12-14 N
Ensure that testing and maintenance of electrical equipment is performed. Fire Safety 2023-09-14 2023-12-14 N
Have proper fire barriers, ventilation and signs for the transfilling of oxygen. Fire Safety 2023-09-14 2023-12-14 N
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. Health 2023-10-23 2023-10-28 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 2023-09-13 2023-10-25 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 2023-09-13 2023-10-25 N
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Health 2023-09-13 2023-10-25 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 2023-09-13 2023-10-25 N
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. Health 2023-09-13 2023-10-25 N
Assess the resident when there is a significant change in condition Health 2023-09-13 2023-10-25 N
Encode each resident?s assessment data and transmit these data to the State within 7 days of assessment. Health 2023-09-13 2023-10-25 N
Ensure each resident receives an accurate assessment. Health 2023-09-13 2023-10-25 N
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted Health 2023-09-13 2023-10-25 N
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2023-09-13 2023-10-25 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 2023-09-13 2023-10-25 N
Provide care and assistance to perform activities of daily living for any resident who is unable. Health 2023-09-13 2023-10-25 N
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2023-09-13 2023-10-25 N
Provide enough food/fluids to maintain a resident's health. Health 2023-09-13 2023-10-25 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 2023-09-13 2023-10-25 N
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Health 2023-09-13 2023-10-25 N
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2023-09-13 2023-10-25 Y
Develop and maintain an Emergency Preparedness Program (EP). Fire Safety 2023-09-14 2023-10-19 N
Include a process for Emergency Preparedness collaboration. Fire Safety 2023-09-14 2023-10-19 N
Develop Emergency Preparedness policies and procedures. Fire Safety 2023-09-14 2023-10-19 N
Develop a communication plan. Fire Safety 2023-09-14 2023-10-19 N
Establish emergency prep training and testing. Fire Safety 2023-09-14 2023-10-19 N
Establish staff and initial training requirements. Fire Safety 2023-09-14 2023-10-19 N
Keep aisles, corridors, and exits free of obstruction in case of emergency. Fire Safety 2023-09-14 2023-10-19 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 2023-09-14 2023-10-19 N
Install emergency lighting that can last at least 1 1/2 hours. Fire Safety 2023-09-14 2023-10-19 N
Have properly located and lighted "Exit" signs. Fire Safety 2023-09-14 2023-10-19 N
Follow proper procedures when the fire alarm was out of service for more than 4 hours. Fire Safety 2023-09-14 2023-10-19 N
Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. Fire Safety 2023-09-14 2023-10-19 N
Install smoke barrier doors that can resist smoke for at least 20 minutes. Fire Safety 2023-09-14 2023-10-19 N
Have properly installed electrical wiring and gas equipment. Fire Safety 2023-09-14 2023-10-19 N
Ensure that HVAC heat units are suspended and out of the reach of patients and can be shut off if unit is working improperly. Fire Safety 2023-09-14 2023-10-19 N
Have elevators that firefighters can control in the event of a fire. Fire Safety 2023-09-14 2023-10-19 N
Provide a written emergency evacuation plan. Fire Safety 2023-09-14 2023-10-19 N
Have simulated fire drills held at unexpected times. Fire Safety 2023-09-14 2023-10-19 N
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. Fire Safety 2023-09-14 2023-10-19 N
To conduct inspection, testing and maintenance of fire doors by qualified individuals. Fire Safety 2023-09-14 2023-10-19 N
Have generator or other power source capable of supplying service within 10 seconds. Fire Safety 2023-09-14 2023-10-19 N
Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk. Fire Safety 2023-09-14 2023-10-19 N
Develop and maintain an Emergency Preparedness Program (EP). Fire Safety 2022-08-01 2022-09-25 N
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2022-09-13 2022-09-24 Y
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2022-08-16 2022-09-08 Y
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Health 2022-07-30 2022-08-31 N
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. Health 2022-07-30 2022-08-31 N
Provide care and assistance to perform activities of daily living for any resident who is unable. Health 2022-07-30 2022-08-31 N
Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident?s advance directives. Health 2022-07-30 2022-08-31 N
Provide safe and appropriate respiratory care for a resident when needed. Health 2022-07-30 2022-08-31 N
Ensure that residents are free from significant medication errors. Health 2022-07-30 2022-08-31 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 2022-07-30 2022-08-31 N
Provide and implement an infection prevention and control program. Health 2022-07-30 2022-08-31 N
Have generator or other power source capable of supplying service within 10 seconds. Fire Safety 2022-08-01 2022-08-31 N
Conduct testing and exercise requirements. Fire Safety 2022-08-01 2022-08-30 N
Meet other general requirements. Fire Safety 2022-08-01 2022-08-30 N
Have properly located and lighted "Exit" signs. Fire Safety 2022-08-01 2022-08-30 N
Install a fire alarm system that can be heard throughout the facility. Fire Safety 2022-08-01 2022-08-30 N
Have approved installation, maintenance and testing program for fire alarm systems. Fire Safety 2022-08-01 2022-08-30 N
Follow proper procedures when the fire alarm was out of service for more than 4 hours. Fire Safety 2022-08-01 2022-08-30 N
Inspect, test, and maintain automatic sprinkler systems. Fire Safety 2022-08-01 2022-08-30 N
Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. Fire Safety 2022-08-01 2022-08-30 N
Install corridor and hallway doors that block smoke. Fire Safety 2022-08-01 2022-08-30 N
Install smoke barrier doors that can resist smoke for at least 20 minutes. Fire Safety 2022-08-01 2022-08-30 N
Have properly installed electrical wiring and gas equipment. Fire Safety 2022-08-01 2022-08-30 N
Ensure proper usage of power strips and extension cords. Fire Safety 2022-08-01 2022-08-30 N
Ensure that testing and maintenance of electrical equipment is performed. Fire Safety 2022-08-01 2022-08-30 N
Provide and implement an infection prevention and control program. Health 2022-02-25 2022-04-13 Y
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Health 2022-02-25 2022-04-04 Y
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 2022-02-25 2022-04-04 Y
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2022-02-25 2022-04-04 Y
Develop and implement policies and procedures to prevent abuse, neglect, and theft. Health 2022-02-25 2022-04-04 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2022-02-25 2022-04-04 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 2022-02-25 2022-04-04 Y
Administer the facility in a manner that enables it to use its resources effectively and efficiently. Health 2022-02-25 2022-04-04 Y
Develop and implement policies and procedures to prevent abuse, neglect, and theft. Health 2021-10-07 2021-11-08 Y
Administer the facility in a manner that enables it to use its resources effectively and efficiently. Health 2021-10-07 2021-11-08 Y
Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility. Health 2021-10-07 2021-11-08 Y
Have a plan that describes the process for conducting QAPI and QAA activities. Health 2021-10-07 2021-11-08 Y
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2021-09-15 2021-11-08 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2021-09-15 2021-11-08 Y
Administer the facility in a manner that enables it to use its resources effectively and efficiently. Health 2021-09-15 2021-11-08 Y
Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility. Health 2021-09-15 2021-11-08 Y
Develop and implement policies and procedures to prevent abuse, neglect, and theft. Health 2021-08-17 2021-11-08 Y
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Health 2021-08-17 2021-11-08 Y
Respond appropriately to all alleged violations. Health 2021-08-17 2021-11-08 Y
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2021-07-12 2021-11-08 Y
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2021-07-12 2021-11-08 Y
Provide safe, appropriate pain management for a resident who requires such services. Health 2021-08-17 2021-09-15 Y
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Health 2021-08-17 2021-09-15 Y
Ensure that residents are free from significant medication errors. Health 2021-08-17 2021-09-15 Y
Provide properly protected cooking facilities. Fire Safety 2020-02-05 2020-06-15 N
Inspect, test, and maintain automatic sprinkler systems. Fire Safety 2020-02-05 2020-06-05 N
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. Fire Safety 2020-02-05 2020-04-24 N
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. Health 2020-02-26 2020-04-21 N
Honor the resident's right to organize and participate in resident/family groups in the facility. Health 2020-02-26 2020-04-21 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 2020-02-26 2020-04-21 N
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2020-02-26 2020-04-21 N
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. Health 2020-02-26 2020-04-21 N
Develop and implement policies and procedures to prevent abuse, neglect, and theft. Health 2020-02-26 2020-04-21 N
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Health 2020-02-26 2020-04-21 N
Respond appropriately to all alleged violations. Health 2020-02-26 2020-04-21 N
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Health 2020-02-26 2020-04-21 N
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. Health 2020-02-26 2020-04-21 N
Assess the resident when there is a significant change in condition Health 2020-02-26 2020-04-21 N
Ensure each resident receives an accurate assessment. Health 2020-02-26 2020-04-21 N
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted Health 2020-02-26 2020-04-21 N
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2020-02-26 2020-04-21 N
Provide care and assistance to perform activities of daily living for any resident who is unable. Health 2020-02-26 2020-04-21 N
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2020-02-26 2020-04-21 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 2020-02-26 2020-04-21 N
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2020-02-26 2020-04-21 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 2020-02-26 2020-04-21 N
Provide enough food/fluids to maintain a resident's health. Health 2020-02-26 2020-04-21 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 2020-02-26 2020-04-21 N
Provide safe and appropriate respiratory care for a resident when needed. Health 2020-02-26 2020-04-21 N
Provide safe, appropriate pain management for a resident who requires such services. Health 2020-02-26 2020-04-21 N
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. Health 2020-02-26 2020-04-21 N
Observe each nurse aide's job performance and give regular training. Health 2020-02-26 2020-04-21 N
Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. Health 2020-02-26 2020-04-21 N
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Health 2020-02-26 2020-04-21 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 2020-02-26 2020-04-21 N
Ensure each resident?s drug regimen must be free from unnecessary drugs. Health 2020-02-26 2020-04-21 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 2020-02-26 2020-04-21 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 2020-02-26 2020-04-21 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 2020-02-26 2020-04-21 N
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Health 2020-02-26 2020-04-21 N
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2020-02-26 2020-04-21 N
Have a policy regarding use and storage of foods brought to residents by family and other visitors. Health 2020-02-26 2020-04-21 N
Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations and emergencies. Health 2020-02-26 2020-04-21 N
Provide and implement an infection prevention and control program. Health 2020-02-26 2020-04-21 N
Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation. Health 2020-02-26 2020-04-21 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 2020-02-26 2020-04-21 N
Have exits that are accessible at all times. Fire Safety 2020-02-05 2020-03-09 N
Have properly located and lighted "Exit" signs. Fire Safety 2020-02-05 2020-03-09 N
Properly select, install, inspect, or maintain portable fire extinguishes. Fire Safety 2020-02-05 2020-03-09 N
Install corridor and hallway doors that block smoke. Fire Safety 2020-02-05 2020-03-09 N
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. Fire Safety 2020-02-05 2020-03-09 N
Have generator or other power source capable of supplying service within 10 seconds. Fire Safety 2020-02-05 2020-03-09 N
Ensure proper usage of power strips and extension cords. Fire Safety 2020-02-05 2020-03-09 N
Have proper medical gas storage and administration areas. Fire Safety 2020-02-05 2020-03-09 N