A list of the most recent deficiencies for Montesano Health - Rehab 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? |
|---|---|---|---|---|
| Ensure that residents are fully informed and understand their health status, care and treatments. | Health | 2022-07-25 | 2022-08-31 | N |
| Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | Health | 2022-07-25 | 2022-08-31 | 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 | 2022-07-25 | 2022-08-31 | N |
| Provide activities to meet all resident's needs. | Health | 2022-07-25 | 2022-08-31 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2022-07-25 | 2022-08-31 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2022-07-25 | 2022-08-31 | N |
| Observe each nurse aide's job performance and give regular training. | Health | 2022-07-25 | 2022-08-31 | N |
| Post nurse staffing information every day. | Health | 2022-07-25 | 2022-08-31 | N |
| Provide or get specialized rehabilitative services as required for a resident. | Health | 2022-07-25 | 2022-08-31 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-07-25 | 2022-08-31 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2022-07-25 | 2022-08-31 | Y |
| Address subsistence needs for staff and patients. | Fire Safety | 2022-07-22 | 2022-08-26 | N |
| Establish procedures for tracking staff and patients during an emergency. | Fire Safety | 2022-07-22 | 2022-08-26 | N |
| Establish staff and initial training requirements. | Fire Safety | 2022-07-22 | 2022-08-26 | N |
| Conduct testing and exercise requirements. | Fire Safety | 2022-07-22 | 2022-08-26 | N |
| Install proper backup exit lighting. | Fire Safety | 2022-07-22 | 2022-08-26 | 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 | 2022-07-22 | 2022-08-26 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2022-07-22 | 2022-08-26 | N |
| Install a fire alarm system that can be heard throughout the facility. | Fire Safety | 2022-07-22 | 2022-08-26 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2022-07-22 | 2022-08-26 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2022-07-22 | 2022-08-26 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-07-22 | 2022-08-26 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2022-07-22 | 2022-08-26 | N |
| Provide a written emergency evacuation plan. | Fire Safety | 2022-07-22 | 2022-08-26 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2022-07-22 | 2022-08-26 | N |
| Have restrictions on the use of portable space heaters. | Fire Safety | 2022-07-22 | 2022-08-26 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2022-07-22 | 2022-08-26 | N |
| Ensure that testing and maintenance of electrical equipment is performed. | Fire Safety | 2022-07-22 | 2022-08-26 | N |
| Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk. | Fire Safety | 2022-07-22 | 2022-08-26 | N |
| Have proper fire barriers, ventilation and signs for the transfilling of oxygen. | Fire Safety | 2022-07-22 | 2022-08-26 | N |
| Ensure precautions for handling oxygen cylinders and equipment are correctly followed. | Fire Safety | 2022-07-22 | 2022-08-26 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2022-04-20 | 2022-05-27 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2021-11-18 | 2021-12-22 | Y |
| Provide doctor's orders for the resident's immediate care at the time the resident was admitted. | Health | 2021-07-15 | 2021-08-20 | Y |
| Ensure that residents are fully informed and understand their health status, care and treatments. | Health | 2021-04-26 | 2021-06-10 | Y |
| 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 | 2021-04-26 | 2021-06-10 | Y |
| Ensure that residents are fully informed and understand their health status, care and treatments. | Health | 2020-01-28 | 2020-07-31 | N |
| Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | Health | 2020-01-28 | 2020-07-31 | 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 | 2020-01-28 | 2020-07-31 | N |
| Provide activities to meet all resident's needs. | Health | 2020-01-28 | 2020-07-31 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2020-01-28 | 2020-07-31 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2020-01-28 | 2020-07-31 | N |
| Provide safe, appropriate pain management for a resident who requires such services. | Health | 2020-01-28 | 2020-07-31 | N |
| Ensure that the resident and his/her doctor meet face-to-face at all required visits. | Health | 2020-01-28 | 2020-07-31 | N |
| 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 | 2020-01-28 | 2020-07-31 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2020-01-28 | 2020-07-31 | N |
| Provide and implement an infection prevention and control program. | Health | 2020-01-28 | 2020-07-31 | N |
| Implement a program that monitors antibiotic use. | Health | 2020-01-28 | 2020-07-31 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2020-01-28 | 2020-07-31 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2019-03-27 | 2019-05-01 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2019-03-27 | 2019-05-01 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2019-03-27 | 2019-05-01 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2019-03-27 | 2019-05-01 | N |
| Ensure gas cylinders are properly stored. | Fire Safety | 2019-03-27 | 2019-05-01 | N |
| Ensure medical gas and vacuum systems have documented maintenance programs. | Fire Safety | 2019-03-27 | 2019-05-01 | N |
| Ensure gas and vacuum piping is labeled. | Fire Safety | 2019-03-27 | 2019-05-01 | N |
| Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made. | Health | 2019-03-25 | 2019-04-25 | 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 | 2019-03-25 | 2019-04-25 | 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 | 2019-03-25 | 2019-04-25 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2019-03-25 | 2019-04-25 | 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 | 2019-03-25 | 2019-04-25 | N |
| Encode each resident?s assessment data and transmit these data to the State within 7 days of assessment. | Health | 2019-03-25 | 2019-04-25 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2019-03-25 | 2019-04-25 | 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 | 2019-03-25 | 2019-04-25 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2019-03-25 | 2019-04-25 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2019-03-25 | 2019-04-25 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2019-03-25 | 2019-04-25 | 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 | 2019-03-25 | 2019-04-25 | N |
| Provide at least one room set aside to use as a resident dining room and for activities, that is a good size, with good lighting, air flow and furniture. | Health | 2019-03-25 | 2019-04-25 | N |
