A list of the most recent deficiencies for Edenbrook of Green Bay. 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 each resident?s drug regimen must be free from unnecessary drugs. | Health | 2023-07-26 | 2023-08-24 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-07-26 | 2023-08-24 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-07-26 | 2023-08-24 | Y |
| Provide safe, appropriate pain management for a resident who requires such services. | Health | 2023-07-26 | 2023-08-24 | Y |
| Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2023-07-26 | 2023-08-24 | 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 | 2023-07-26 | 2023-08-24 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2023-07-26 | 2023-08-24 | 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 | 2023-07-26 | 2023-08-24 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-07-26 | 2023-08-24 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2023-07-26 | 2023-08-24 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2023-07-26 | 2023-08-24 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-07-26 | 2023-08-24 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2023-07-26 | 2023-08-24 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2022-08-10 | 2022-09-06 | 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 | 2022-08-10 | 2022-09-06 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2022-08-10 | 2022-09-06 | 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 | 2022-08-10 | 2022-08-30 | 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 | 2022-08-10 | 2022-08-30 | N |
| Install a fire alarm system that can be heard throughout the facility. | Fire Safety | 2022-08-10 | 2022-08-30 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2022-08-10 | 2022-08-30 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2021-07-14 | 2021-08-13 | N |
| Provide and implement an infection prevention and control program. | Health | 2021-07-14 | 2021-08-13 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2021-07-13 | 2021-08-13 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2021-07-13 | 2021-08-13 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2021-07-13 | 2021-08-13 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2021-07-13 | 2021-08-13 | N |
