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Deficiency Records for The Medical Suites at Oak Creek
View the most recent health deficiencies and inspection results for The Medical Suites at Oak Creek. Stay informed about quality of care issues.
View the most recent health deficiencies and inspection results for The Medical Suites at Oak Creek. Stay informed about quality of care issues.
| Deficiency | Type of Deficiency | Deficiency Date | Date Corrected | Resulted from a Complaint? |
|---|---|---|---|---|
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2025-12-18 | 2026-01-18 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2025-12-18 | 2026-01-18 | Y |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2025-12-18 | 2026-01-18 | Y |
| Provide and implement an infection prevention and control program. | Health | 2025-10-03 | 2025-11-10 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2025-10-03 | 2025-11-10 | 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 | 2025-10-03 | 2025-11-10 | N |
| Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. | Health | 2025-10-03 | 2025-11-10 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2025-10-03 | 2025-11-10 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2025-10-03 | 2025-11-10 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2025-10-03 | 2025-11-10 | N |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2025-10-03 | 2025-11-10 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2025-10-03 | 2025-11-10 | N |
| Have a plan that describes the process for conducting QAPI and QAA activities. | Health | 2025-10-03 | 2025-11-10 | N |
| Implement a program that monitors antibiotic use. | Health | 2025-10-03 | 2025-11-10 | N |
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2025-10-03 | 2025-11-10 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2025-10-03 | 2025-11-10 | Y |
| Provide safe, appropriate pain management for a resident who requires such services. | Health | 2025-10-03 | 2025-11-10 | Y |
| Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. | Health | 2025-10-03 | 2025-11-10 | Y |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2025-10-03 | 2025-11-10 | Y |
| 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 | 2025-10-03 | 2025-11-10 | Y |
| Dispose of garbage and refuse properly. | Health | 2025-10-03 | 2025-11-10 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2025-10-03 | 2025-11-10 | Y |
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2025-08-21 | 2025-09-10 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2025-07-08 | 2025-08-04 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2025-07-08 | 2025-08-04 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2025-06-04 | 2025-07-01 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2025-06-04 | 2025-07-01 | Y |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2025-04-03 | 2025-04-28 | Y |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2025-04-03 | 2025-04-28 | Y |
| 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 | 2025-04-03 | 2025-04-28 | Y |
| Ensure medication error rates are not 5 percent or greater. | Health | 2025-04-03 | 2025-04-28 | Y |
| Provide timely, quality laboratory services/tests to meet the needs of residents. | Health | 2025-04-03 | 2025-04-28 | Y |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2025-04-03 | 2025-04-28 | Y |
| 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 | 2024-12-04 | 2024-12-19 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2024-12-04 | 2024-12-19 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2024-09-11 | 2024-10-01 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2024-09-11 | 2024-10-01 | Y |
| Develop, implement, and/or maintain an effective training program for all new and existing staff members. | Health | 2024-09-11 | 2024-10-01 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2024-07-15 | 2024-10-01 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2024-07-15 | 2024-10-01 | Y |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2024-07-15 | 2024-09-11 | N |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2024-07-15 | 2024-08-12 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2024-07-15 | 2024-08-12 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2024-07-15 | 2024-08-12 | Y |
| Respond appropriately to all alleged violations. | Health | 2024-07-15 | 2024-08-12 | Y |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2024-07-15 | 2024-08-12 | Y |
| Provide activities to meet all resident's needs. | Health | 2024-07-15 | 2024-08-12 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2024-07-15 | 2024-08-12 | Y |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2024-07-15 | 2024-08-12 | 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 | 2024-07-15 | 2024-08-12 | N |
| Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. | Health | 2024-07-15 | 2024-08-12 | N |
| Provide and implement an infection prevention and control program. | Health | 2024-07-15 | 2024-08-12 | N |
| Dispose of garbage and refuse properly. | Health | 2024-07-15 | 2024-08-12 | N |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2024-07-15 | 2024-08-12 | 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 | 2024-07-15 | 2024-08-12 | 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 | 2024-07-15 | 2024-08-12 | 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 | 2024-07-15 | 2024-08-12 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2024-07-15 | 2024-08-12 | 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 | 2024-07-15 | 2024-08-12 | 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 | 2024-07-15 | 2024-08-12 | N |
| Have properly located and lighted "Exit" signs. | Fire Safety | 2024-07-15 | 2024-08-12 | N |
| Install a fire alarm system that can be heard throughout the facility. | Fire Safety | 2024-07-15 | 2024-08-12 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2024-07-15 | 2024-08-12 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2024-07-15 | 2024-08-12 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2024-07-15 | 2024-08-12 | N |
| Provide a written emergency evacuation plan. | Fire Safety | 2024-07-15 | 2024-08-12 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2024-07-15 | 2024-08-12 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2024-07-15 | 2024-08-12 | N |
| Have restrictions on the use of portable space heaters. | Fire Safety | 2024-07-15 | 2024-08-12 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2024-07-15 | 2024-08-12 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2024-07-15 | 2024-08-12 | N |
| Conduct risk assessment and an All-Hazards approach. | Fire Safety | 2024-07-15 | 2024-08-08 | N |
| Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. | Health | 2024-04-17 | 2024-05-02 | Y |
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2024-04-17 | 2024-05-02 | Y |
| 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 | 2024-04-17 | 2024-05-02 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2024-04-17 | 2024-05-02 | 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 | 2024-04-17 | 2024-05-02 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2024-04-17 | 2024-05-02 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2024-04-17 | 2024-05-02 | Y |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2024-04-17 | 2024-05-02 | Y |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2024-04-17 | 2024-05-02 | Y |
| Ensure medication error rates are not 5 percent or greater. | Health | 2024-04-17 | 2024-05-02 | Y |
| 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 | 2024-04-17 | 2024-05-02 | Y |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-07-27 | 2023-10-13 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-09-19 | 2023-09-09 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-09-19 | 2023-09-09 | Y |
| Provide enough food/fluids to maintain a resident's health. | Health | 2023-09-19 | 2023-09-09 | Y |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2023-09-19 | 2023-09-09 | Y |
| Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2023-07-27 | 2023-08-29 | N |
| PASARR screening for Mental disorders or Intellectual Disabilities | Health | 2023-07-27 | 2023-08-22 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-07-27 | 2023-08-22 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2023-07-27 | 2023-08-22 | 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 | 2023-07-27 | 2023-08-22 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-07-27 | 2023-08-22 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2023-07-27 | 2023-08-22 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-07-27 | 2023-08-22 | 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 | 2023-07-27 | 2023-08-22 | 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 | 2023-07-27 | 2023-08-22 | 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 | 2023-07-27 | 2023-08-22 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2023-07-27 | 2023-08-22 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-07-27 | 2023-08-22 | N |
| Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members. | Health | 2023-07-27 | 2023-08-22 | N |
| Conduct mandatory training, for all staff, on the facility?s Quality Assurance and Performance Improvement Program. | Health | 2023-07-27 | 2023-08-22 | N |
| Provide training in compliance and ethics. | Health | 2023-07-27 | 2023-08-22 | N |
| Provide behavior health training consistent with the requirements and as determined by a facility assessment. | Health | 2023-07-27 | 2023-08-22 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2023-07-27 | 2023-08-22 | Y |
| Respond appropriately to all alleged violations. | Health | 2023-07-27 | 2023-08-22 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2023-07-27 | 2023-08-22 | Y |
| Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | Health | 2023-07-27 | 2023-08-22 | N |
| Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2023-07-27 | 2023-08-22 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2023-07-27 | 2023-08-22 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-07-27 | 2023-08-22 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2023-07-27 | 2023-08-22 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2023-07-27 | 2023-08-22 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2023-07-27 | 2023-08-22 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2023-07-27 | 2023-08-22 | N |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2023-07-27 | 2023-08-22 | N |
| Have proper fire barriers, ventilation and signs for the transfilling of oxygen. | Fire Safety | 2022-03-30 | 2022-04-25 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2022-03-30 | 2022-04-25 | N |
| Meet requirements for the installation and maintenance of electrical systems. | Fire Safety | 2022-03-30 | 2022-04-25 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2022-03-30 | 2022-04-25 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2022-03-30 | 2022-04-25 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-03-30 | 2022-04-25 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2022-03-30 | 2022-04-25 | 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 | 2022-03-30 | 2022-04-25 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2022-03-30 | 2022-04-25 | N |
| Establish emergency prep training and testing. | Fire Safety | 2022-03-30 | 2022-04-25 | N |