Deficiency Records for Champions Healthcare at Willowbrook
Updated as of May 01, 2019
This is not the most recent data for Champions Healthcare at Willowbrook. For the most recent information, click here.
A list of the most recent deficiencies for Champions Healthcare at Willowbrook. 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? |
|---|---|---|---|---|
| PASARR screening for Mental disorders or Intellectual Disabilities | Health | 2018-09-13 | 2018-10-05 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2018-09-13 | 2018-10-05 | N |
| Ensure that residents are free from significant medication errors. | Health | 2018-09-13 | 2018-10-05 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2018-09-13 | 2018-10-05 | N |
| 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 | 2018-09-13 | 2018-10-03 | 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 | 2018-09-13 | 2018-10-03 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2018-09-13 | 2018-10-03 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2018-09-13 | 2018-10-03 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2018-08-12 | 2018-08-29 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2018-08-12 | 2018-08-29 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2018-05-08 | 2018-05-25 | Y |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2018-05-08 | 2018-05-25 | 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 | 2017-09-19 | 2017-10-27 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2017-09-19 | 2017-10-27 | N |
| Provide care by qualified persons according to each resident's written plan of care. | Health | 2017-09-21 | 2017-10-27 | N |
| Properly care for residents needing special services, including: injections, colostomy, ureostomy, ileostomy, tracheostomy care, tracheal suctioning, respiratory care, foot care, and prostheses. | Health | 2017-09-21 | 2017-10-27 | N |
| Maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards. | Health | 2017-09-21 | 2017-10-27 | N |
| Have a program that investigates, controls and keeps infection from spreading. | Health | 2017-09-21 | 2017-10-27 | N |
| Keep accurate, complete and organized clinical records on each resident that meet professional standards. | Health | 2017-09-21 | 2017-10-27 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2017-03-17 | 2017-04-14 | Y |
| Quickly tell the resident's doctor the results of laboratory tests. | Health | 2017-03-17 | 2017-04-14 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2016-12-13 | 2016-12-16 | Y |
| Develop and implement policies for 1) screening and training employees; and the 2) prevention, identification, investigation, and reporting of any abuse, neglect, mistreatment and misappropriation of property. | Health | 2016-12-13 | 2016-12-16 | Y |
| Provide necessary care and services to maintain or improve the highest well being of each resident . | Health | 2016-12-13 | 2016-12-16 | Y |
| Make sure that the facility is administered in an acceptable way that maintains the well-being of each resident . | Health | 2016-12-13 | 2016-12-16 | Y |
| Smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2016-09-07 | 2016-10-10 | N |
| Exits that are accessible at all times. | Fire Safety | 2016-09-07 | 2016-10-10 | N |
| An approved automatic sprinkler system connected to the fire alarm system. | Fire Safety | 2016-09-07 | 2016-10-10 | N |
| Properly working alarms on sprinkler valves. | Fire Safety | 2016-09-07 | 2016-10-10 | N |
| Portable fire extinguishers. | Fire Safety | 2016-09-07 | 2016-10-10 | N |
| Posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2016-09-07 | 2016-10-10 | N |
| Exits that are free from obstructions and can be used at all times. | Fire Safety | 2016-09-07 | 2016-10-10 | N |
| Weekly inspections and monthly testing of generators. | Fire Safety | 2016-09-07 | 2016-10-10 | N |
| Completely assess the resident at least every twelve months. | Health | 2016-09-09 | 2016-10-10 | N |
| Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2016-09-09 | 2016-10-10 | N |
| Provide care by qualified persons according to each resident's written plan of care. | Health | 2016-09-09 | 2016-10-10 | N |
| Coordinate assessments with the pre-admission screening and resident review program for mentally-ill and mentally-retarded patients. | Health | 2016-09-09 | 2016-10-10 | N |
| Ensure that residents are safe from serious medication errors. | Health | 2016-09-09 | 2016-10-10 | N |
| Store, cook, and serve food in a safe and clean way. | Health | 2016-09-09 | 2016-10-10 | N |
| Provide routine and emergency drugs through a licensed pharmacist and only under the general supervision of a licensed nurse. | Health | 2016-09-09 | 2016-10-10 | N |
| Have a program that investigates, controls and keeps infection from spreading. | Health | 2016-09-09 | 2016-10-10 | N |
| Keep accurate, complete and organized clinical records on each resident that meet professional standards. | Health | 2016-09-09 | 2016-10-10 | N |
