Deficiency Records for The Oaks at Radford Hills Healthcare Center
Updated as of April 01, 2024
A list of the most recent deficiencies for The Oaks at Radford Hills 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? |
|---|---|---|---|---|
| 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 | 2024-02-16 | 2024-03-15 | Y |
| Allow resident to participate in the development and implementation of his or her person-centered plan of care. | Health | 2023-10-19 | 2023-11-10 | Y |
| Encode each resident?s assessment data and transmit these data to the State within 7 days of assessment. | Health | 2023-10-19 | 2023-11-10 | Y |
| Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. | Health | 2023-10-19 | 2023-11-10 | Y |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-10-19 | 2023-11-10 | Y |
| Develop, implement, and/or maintain an effective training program for all new and existing staff members. | Health | 2023-10-19 | 2023-11-10 | Y |
| Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members. | Health | 2023-10-19 | 2023-11-10 | Y |
| Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents. | Health | 2023-10-19 | 2023-11-10 | Y |
| Include as part of its infection prevention and control program, mandatory training that includes written standards, policies, and procedures for the program. | Health | 2023-10-19 | 2023-11-10 | Y |
| Provide training in compliance and ethics. | Health | 2023-10-19 | 2023-11-10 | Y |
| Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2023-10-18 | 2023-11-10 | 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 | 2023-10-18 | 2023-10-19 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2023-08-31 | 2023-09-20 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-07-13 | 2023-08-12 | Y |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2023-07-13 | 2023-08-12 | Y |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-07-13 | 2023-08-12 | Y |
| Provide and implement an infection prevention and control program. | Health | 2023-02-17 | 2023-03-17 | Y |
| Provide and implement an infection prevention and control program. | Health | 2022-09-22 | 2022-10-22 | N |
| Allow resident to participate in the development and implementation of his or her person-centered plan of care. | Health | 2022-09-22 | 2022-10-12 | N |
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2022-09-22 | 2022-10-12 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2022-09-22 | 2022-10-12 | N |
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2022-09-22 | 2022-10-12 | 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 | 2022-09-22 | 2022-10-12 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-09-22 | 2022-10-12 | N |
| Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | Health | 2022-07-25 | 2022-07-28 | Y |
| Administer the facility in a manner that enables it to use its resources effectively and efficiently. | Health | 2022-07-25 | 2022-07-28 | Y |
| Provide and implement an infection prevention and control program. | Health | 2022-07-25 | 2022-07-28 | Y |
| Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. | Health | 2022-07-06 | 2022-07-18 | Y |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-06-02 | 2022-06-03 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2022-04-01 | 2022-04-22 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-04-01 | 2022-04-22 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2022-04-01 | 2022-04-20 | Y |
| Respond appropriately to all alleged violations. | Health | 2022-04-01 | 2022-04-20 | Y |
| Provide and implement an infection prevention and control program. | Health | 2022-01-14 | 2022-01-17 | Y |
| Implement emergency and standby power systems. | Fire Safety | 2021-07-29 | 2021-08-27 | N |
| Have a complete alarm system manually initiated and initiated by fire sprinkler system connection. | Fire Safety | 2021-07-29 | 2021-08-27 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2021-07-29 | 2021-08-27 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2021-07-29 | 2021-08-27 | N |
| Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | Health | 2021-07-13 | 2021-07-28 | 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 | 2021-07-13 | 2021-07-28 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2021-07-13 | 2021-07-28 | N |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2021-07-13 | 2021-07-28 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2021-07-13 | 2021-07-28 | Y |
| Respond appropriately to all alleged violations. | Health | 2021-07-13 | 2021-07-28 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-07-13 | 2021-07-28 | Y |
| Provide and implement an infection prevention and control program. | Health | 2021-07-13 | 2021-07-28 | Y |
| Assure the security of all personal funds of residents deposited with the facility. | Health | 2021-07-13 | 2021-07-14 | N |
