A list of the most recent deficiencies for Green Bay Health Services. 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 receives an accurate assessment. | Health | 2023-04-12 | 2023-05-23 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-04-12 | 2023-05-23 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-04-12 | 2023-05-23 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-04-12 | 2023-05-23 | N |
| Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. | Health | 2023-04-12 | 2023-05-23 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2023-04-13 | 2023-05-13 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-04-13 | 2023-05-13 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2023-04-13 | 2023-05-13 | N |
| Meet requirements for the installation and maintenance of electrical systems. | Fire Safety | 2023-04-13 | 2023-05-13 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2022-09-27 | 2022-10-25 | Y |
| Give the resident's representative the ability to exercise the resident's rights. | Health | 2022-03-02 | 2022-04-01 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-03-02 | 2022-04-01 | 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 | 2022-03-02 | 2022-04-01 | N |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2022-03-02 | 2022-04-01 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2022-03-04 | 2022-04-01 | N |
| Install resident room doors of proper design and width. | Fire Safety | 2022-03-04 | 2022-04-01 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-03-04 | 2022-04-01 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2022-03-04 | 2022-04-01 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2022-03-04 | 2022-04-01 | 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 | 2021-07-28 | 2021-08-31 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2021-07-28 | 2021-08-31 | Y |
| Respond appropriately to all alleged violations. | Health | 2021-07-28 | 2021-08-31 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2021-07-28 | 2021-08-31 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2021-07-28 | 2021-08-31 | 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 | 2021-07-28 | 2021-08-31 | Y |
| 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 | 2021-07-28 | 2021-08-31 | 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 | 2021-07-28 | 2021-08-31 | Y |
| Post nurse staffing information every day. | Health | 2021-07-28 | 2021-08-31 | Y |
| Provide and implement an infection prevention and control program. | Health | 2021-07-28 | 2021-08-31 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-06-14 | 2021-07-08 | Y |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2021-04-07 | 2021-05-06 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2021-04-07 | 2021-05-06 | 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 | 2021-04-07 | 2021-05-06 | N |
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2021-04-07 | 2021-05-06 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2021-04-07 | 2021-05-06 | 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 | 2021-04-07 | 2021-05-06 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2021-04-07 | 2021-05-06 | N |
| Provide appropriate foot care. | Health | 2021-04-07 | 2021-05-06 | 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 | 2021-04-07 | 2021-05-06 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2021-04-07 | 2021-05-06 | 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 | 2021-04-07 | 2021-05-06 | 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 | 2021-04-07 | 2021-05-06 | N |
| Provide and implement an infection prevention and control program. | Health | 2021-04-07 | 2021-05-06 | N |
| Have properly located and lighted "Exit" signs. | Fire Safety | 2021-04-05 | 2021-05-06 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2021-04-05 | 2021-05-06 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2021-04-05 | 2021-05-06 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2021-04-05 | 2021-05-06 | N |
