A list of the most recent deficiencies for Meadowbrook at Chetek. 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 | 2023-03-29 | 2023-04-24 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2023-03-29 | 2023-04-24 | 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 | 2023-03-29 | 2023-04-24 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-03-29 | 2023-04-24 | N |
| Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. | Health | 2023-03-29 | 2023-04-24 | N |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2023-03-29 | 2023-04-24 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2023-03-27 | 2023-04-14 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2023-03-27 | 2023-04-14 | N |
| Meet requirements for the use of electrical equipment. | Fire Safety | 2023-03-27 | 2023-04-14 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2023-03-27 | 2023-04-14 | N |
| Observe each nurse aide's job performance and give regular training. | Health | 2023-01-10 | 2023-02-10 | Y |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2023-01-10 | 2023-02-10 | Y |
| Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | Health | 2022-02-02 | 2022-03-02 | 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 | 2022-02-02 | 2022-03-02 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-02-02 | 2022-03-02 | 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 | 2022-02-03 | 2022-03-02 | N |
| Have exits that are accessible at all times. | Fire Safety | 2022-02-03 | 2022-03-02 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2022-02-03 | 2022-03-02 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2022-02-03 | 2022-03-02 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2022-02-03 | 2022-03-02 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2022-02-03 | 2022-03-02 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2022-02-03 | 2022-03-02 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2022-02-03 | 2022-03-02 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2022-02-03 | 2022-03-02 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2022-02-03 | 2022-03-02 | N |
| Keep all essential equipment working safely. | Health | 2021-09-01 | 2021-10-15 | Y |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2021-09-01 | 2021-10-15 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2020-02-20 | 2020-03-20 | 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 | 2020-02-20 | 2020-03-20 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2020-02-20 | 2020-03-20 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2020-02-18 | 2020-03-13 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2020-02-18 | 2020-03-13 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2020-02-18 | 2020-03-13 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2020-02-18 | 2020-03-13 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2020-02-18 | 2020-03-13 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2020-02-18 | 2020-03-13 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2020-02-18 | 2020-03-13 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2020-02-18 | 2020-03-13 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2020-02-18 | 2020-03-13 | N |
