A list of the most recent deficiencies for Hillcrest Heights Healthcare 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? |
|---|---|---|---|---|
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2023-12-21 | 2024-01-09 | Y |
| Prepare residents for a safe transfer or discharge from the nursing home. | Health | 2023-11-15 | 2023-12-15 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-09-26 | 2023-10-25 | Y |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2023-02-15 | 2023-03-13 | Y |
| Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. | Health | 2022-12-06 | 2023-01-15 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2022-12-07 | 2023-01-06 | Y |
| 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 | 2022-09-08 | 2022-10-08 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2022-09-08 | 2022-10-08 | Y |
| Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility. | Health | 2022-09-08 | 2022-10-08 | Y |
| Have a plan that describes the process for conducting QAPI and QAA activities. | Health | 2022-09-08 | 2022-10-08 | Y |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2022-05-23 | 2022-06-23 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-05-23 | 2022-06-23 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2022-05-23 | 2022-06-23 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2022-05-23 | 2022-06-23 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2022-05-23 | 2022-06-23 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2022-05-23 | 2022-06-23 | N |
| Have power receptacles that are properly grounded. | Fire Safety | 2022-05-23 | 2022-06-23 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2022-05-23 | 2022-06-23 | N |
| Meet requirements for the use of electrical equipment. | Fire Safety | 2022-05-23 | 2022-06-23 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2022-05-23 | 2022-06-23 | N |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2022-05-19 | 2022-06-18 | 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 | 2022-05-19 | 2022-06-18 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-05-19 | 2022-06-18 | 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 | 2022-05-19 | 2022-06-18 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-05-19 | 2022-06-18 | N |
| Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. | Health | 2022-05-19 | 2022-06-18 | N |
| Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. | Health | 2022-05-19 | 2022-06-18 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-05-19 | 2022-06-18 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-05-19 | 2022-06-18 | N |
| Keep all essential equipment working safely. | Health | 2022-05-19 | 2022-06-18 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-03-08 | 2022-05-25 | Y |
| Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | Health | 2022-04-01 | 2022-05-03 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2021-12-01 | 2021-12-31 | Y |
| Provide and implement an infection prevention and control program. | Health | 2021-09-16 | 2021-09-28 | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2021-08-18 | 2021-09-28 | Y |
| Provide and implement an infection prevention and control program. | Health | 2021-09-09 | 2021-09-23 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2019-07-17 | 2019-08-16 | N |
| Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | Health | 2019-07-17 | 2019-08-16 | N |
| Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. | Health | 2019-07-17 | 2019-08-16 | 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 | 2019-07-17 | 2019-08-16 | N |
| Provide safe, appropriate pain management for a resident who requires such services. | Health | 2019-07-17 | 2019-08-16 | 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 | 2019-07-17 | 2019-08-16 | 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 | 2019-07-17 | 2019-08-16 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2019-07-17 | 2019-08-16 | N |
| Provide and implement an infection prevention and control program. | Health | 2019-07-17 | 2019-08-16 | N |
| Implement emergency and standby power systems. | Fire Safety | 2019-07-18 | 2019-08-14 | N |
| Satisfy building requirements after a repair, renovation, modification, or change of user/occupancy. | Fire Safety | 2019-07-18 | 2019-08-14 | N |
| Use approved construction type or materials. | Fire Safety | 2019-07-18 | 2019-08-14 | N |
| Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector. | Fire Safety | 2019-07-18 | 2019-08-14 | N |
| Meet other general requirements that are deficient. | Fire Safety | 2019-07-18 | 2019-08-14 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2019-07-18 | 2019-08-14 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2019-07-18 | 2019-08-14 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2019-07-18 | 2019-08-14 | N |
| List the names and contact information of those in the facility. | Fire Safety | 2018-08-21 | 2018-09-13 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2018-08-21 | 2018-09-13 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2018-08-21 | 2018-09-13 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2018-08-21 | 2018-09-13 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2018-08-21 | 2018-09-13 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2018-06-01 | 2018-07-14 | N |
| Ensure that residents are fully informed and understand their health status, care and treatments. | Health | 2018-06-01 | 2018-07-14 | N |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2018-06-01 | 2018-07-14 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2018-06-01 | 2018-07-14 | N |
| Provide activities to meet all resident's needs. | Health | 2018-06-01 | 2018-07-14 | 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 | 2018-06-01 | 2018-07-14 | N |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2018-06-01 | 2018-07-14 | 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 | 2018-06-01 | 2018-07-14 | N |
| Ensure that residents are free from significant medication errors. | Health | 2018-06-01 | 2018-07-14 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2018-06-01 | 2018-07-14 | N |
| Provide and implement an infection prevention and control program. | Health | 2018-06-01 | 2018-07-14 | N |
| Implement a program that monitors antibiotic use. | Health | 2018-06-01 | 2018-07-14 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-01-25 | Not Fixed | N |
| Report COVID19 data to residents and families. | Health | 2022-01-25 | Not Fixed | N |
