CONTACT INFORMATION REVIEWS & MORE DATA
Deficiency Records for The Pavilion at Sunny Hills
View the most recent health deficiencies and inspection results for The Pavilion at Sunny Hills. Stay informed about quality of care issues.
View the most recent health deficiencies and inspection results for The Pavilion at Sunny Hills. Stay informed about quality of care issues.
| Deficiency | Type of Deficiency | Deficiency Date | Date Corrected | Resulted from a Complaint? |
|---|---|---|---|---|
| Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | Health | 2026-03-26 | 2026-04-16 | 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 | 2026-03-26 | 2026-04-16 | Y |
| Provide enough food/fluids to maintain a resident's health. | Health | 2026-03-26 | 2026-04-16 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2026-02-18 | 2026-03-16 | Y |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2026-01-30 | 2026-02-13 | Y |
| Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | Health | 2025-12-08 | 2025-12-25 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2025-12-08 | 2025-12-25 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2025-07-10 | 2025-07-23 | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2025-05-28 | 2025-06-16 | 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 | 2025-04-28 | 2025-05-28 | N |
| Keep residents' personal and medical records private and confidential. | Health | 2025-04-28 | 2025-05-28 | N |
| Ensure each resident receives an accurate assessment. | Health | 2025-04-28 | 2025-05-28 | N |
| PASARR screening for Mental disorders or Intellectual Disabilities | Health | 2025-04-28 | 2025-05-28 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2025-04-28 | 2025-05-28 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2025-04-28 | 2025-05-28 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2025-04-28 | 2025-05-28 | 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 | 2025-04-28 | 2025-05-28 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2025-04-28 | 2025-05-28 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2025-04-28 | 2025-05-28 | N |
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2025-04-28 | 2025-05-28 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2025-04-28 | 2025-05-28 | Y |
| Keep all essential equipment working safely. | Health | 2025-04-28 | 2025-05-28 | N |
| Provide and implement an infection prevention and control program. | Health | 2025-04-28 | 2025-05-28 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2025-04-28 | 2025-05-28 | N |
| Dispose of garbage and refuse properly. | Health | 2025-04-28 | 2025-05-28 | N |
| Have a policy regarding use and storage of foods brought to residents by family and other visitors. | Health | 2025-04-28 | 2025-05-28 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2025-04-28 | 2025-05-28 | 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 | 2025-04-28 | 2025-05-28 | 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 | 2025-04-28 | 2025-05-28 | 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 | 2025-04-28 | 2025-05-28 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2025-04-28 | 2025-05-28 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2025-04-28 | 2025-05-28 | N |
| Provide safe, appropriate pain management for a resident who requires such services. | Health | 2025-04-28 | 2025-05-28 | N |
| Provide for the safe, appropriate administration of IV fluids for a resident when needed. | Health | 2025-04-28 | 2025-05-28 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2025-04-28 | 2025-05-07 | N |
| Use approved construction type or materials. | Fire Safety | 2025-04-28 | 2025-05-07 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2025-04-28 | 2025-05-07 | N |
| Ensure the facility is licensed under applicable State and local law and operates and provides services in compliance with all applicable Federal, State, and local laws, regulations, and codes, and with accepted professional standards. | Health | 2025-03-18 | 2025-04-17 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2025-03-18 | 2025-04-17 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2024-07-30 | 2024-08-30 | Y |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2024-05-28 | 2024-06-28 | Y |
| Have proper medical gas storage and administration areas. | Fire Safety | 2023-12-07 | 2024-01-08 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2023-12-07 | 2024-01-08 | N |
| Provide a written emergency evacuation plan. | Fire Safety | 2023-12-07 | 2024-01-08 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2023-12-07 | 2024-01-08 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2023-12-07 | 2024-01-08 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2023-12-07 | 2024-01-08 | N |
| Include a process for Emergency Preparedness collaboration. | Fire Safety | 2023-12-07 | 2024-01-08 | 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 | 2023-12-07 | 2024-01-07 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-12-07 | 2024-01-07 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2023-12-07 | 2024-01-07 | N |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2023-12-07 | 2024-01-07 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-12-07 | 2024-01-07 | N |
| Provide for the safe, appropriate administration of IV fluids for a resident when needed. | Health | 2023-12-07 | 2024-01-07 | N |
| Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. | Health | 2023-12-07 | 2024-01-07 | 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 | 2023-12-07 | 2024-01-07 | 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 | 2023-12-07 | 2024-01-07 | 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 | 2023-12-07 | 2024-01-07 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-12-07 | 2024-01-07 | N |
| Dispose of garbage and refuse properly. | Health | 2023-12-07 | 2024-01-07 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-12-07 | 2024-01-07 | N |
| Implement a program that monitors antibiotic use. | Health | 2023-12-07 | 2024-01-07 | N |
| Keep all essential equipment working safely. | Health | 2023-12-07 | 2024-01-07 | N |
| Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame. | Health | 2023-12-07 | 2024-01-07 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-12-07 | 2024-01-07 | N |
| Provide activities to meet all resident's needs. | Health | 2023-12-07 | 2024-01-07 | 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 | 2023-12-07 | 2024-01-07 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-12-07 | 2024-01-07 | 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 | 2023-12-07 | 2024-01-07 | N |
| Keep residents' personal and medical records private and confidential. | Health | 2023-12-07 | 2024-01-07 | N |
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2023-12-07 | 2024-01-07 | N |
| Ensure that residents are fully informed and understand their health status, care and treatments. | Health | 2023-12-07 | 2024-01-07 | N |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-11-09 | 2023-12-08 | Y |
| Protect each resident from the wrongful use of the resident's belongings or money. | Health | 2023-08-29 | 2023-09-29 | Y |
| Not hire anyone with a finding of abuse, neglect, exploitation, or theft. | Health | 2023-08-29 | 2023-09-29 | Y |
| 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 | 2023-07-05 | 2023-07-28 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-06-14 | 2023-07-07 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2023-06-14 | 2023-07-07 | Y |
| Have elevators that firefighters can control in the event of a fire. | Fire Safety | 2021-11-16 | 2021-12-17 | N |
| Use approved construction type or materials. | Fire Safety | 2021-11-16 | 2021-12-17 | 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 | 2021-11-16 | 2021-12-17 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2021-11-16 | 2021-12-17 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2021-11-16 | 2021-12-17 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2021-11-16 | 2021-12-17 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2021-11-16 | 2021-12-17 | N |
| Conduct testing and exercise requirements. | Fire Safety | 2021-11-16 | 2021-12-17 | N |
| Keep all essential equipment working safely. | Health | 2021-11-16 | 2021-12-15 | N |
| Provide and implement an infection prevention and control program. | Health | 2021-11-16 | 2021-12-15 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2021-11-16 | 2021-12-15 | N |
| Dispose of garbage and refuse properly. | Health | 2021-11-16 | 2021-12-15 | N |
| Have a policy regarding use and storage of foods brought to residents by family and other visitors. | Health | 2021-11-16 | 2021-12-15 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2021-11-16 | 2021-12-15 | N |
| Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. | Health | 2021-11-16 | 2021-12-15 | 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 | 2021-11-16 | 2021-12-15 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2021-11-16 | 2021-12-15 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2021-11-16 | 2021-12-15 | N |
| Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. | Health | 2021-11-16 | 2021-12-15 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2021-11-16 | 2021-12-15 | N |
| Provide activities to meet all resident's needs. | Health | 2021-11-16 | 2021-12-15 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2021-11-16 | 2021-12-15 | N |
| Keep residents' personal and medical records private and confidential. | Health | 2021-11-16 | 2021-12-15 | N |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2021-11-16 | 2021-12-15 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2021-11-16 | 2021-12-15 | N |