Deficiency Records for Golden Creek Healthcare and Rehabilitation Center
Updated as of March 01, 2024
A list of the most recent deficiencies for Golden Creek Healthcare and Rehabilitation 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? |
|---|---|---|---|---|
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2023-03-16 | 2023-03-22 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-03-16 | 2023-03-22 | 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 | 2023-03-16 | 2023-03-22 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-03-16 | 2023-03-22 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-07-08 | 2022-07-09 | Y |
| Provide bedrooms that don't allow residents to see each other when privacy is needed. | Health | 2022-07-08 | 2022-07-09 | Y |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2022-07-08 | 2022-07-09 | Y |
| Provide activities to meet all resident's needs. | Health | 2022-06-01 | 2022-06-02 | Y |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-06-01 | 2022-06-02 | Y |
| Provide and implement an infection prevention and control program. | Health | 2022-06-01 | 2022-06-02 | Y |
| 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 | 2022-04-21 | 2022-04-26 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2022-04-21 | 2022-04-26 | N |
| Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. | Health | 2022-02-09 | 2022-02-10 | Y |
| 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 | 2022-01-13 | 2022-01-21 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-01-13 | 2022-01-21 | N |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2021-05-29 | 2021-06-23 | Y |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2021-05-29 | 2021-06-23 | Y |
| Respond appropriately to all alleged violations. | Health | 2021-05-29 | 2021-06-23 | Y |
| Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | Health | 2021-05-29 | 2021-06-23 | Y |
| Administer the facility in a manner that enables it to use its resources effectively and efficiently. | Health | 2021-05-29 | 2021-06-23 | Y |
| Have a plan that describes the process for conducting QAPI and QAA activities. | Health | 2021-05-29 | 2021-06-23 | Y |
| Protect each resident from the wrongful use of the resident's belongings or money. | Health | 2021-05-29 | 2021-05-30 | Y |
| Ensure that building systems meet requirements determined by risk assessment procedures performed by qualified personnel. | Fire Safety | 2019-10-31 | 2019-12-06 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2019-10-31 | 2019-12-06 | N |
| Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. | Health | 2019-10-30 | 2019-11-29 | 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 | 2019-10-30 | 2019-11-29 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2019-10-30 | 2019-11-29 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2019-10-30 | 2019-11-29 | 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 | 2019-10-30 | 2019-11-29 | 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 | 2019-10-30 | 2019-11-29 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2019-10-30 | 2019-11-29 | N |
