A list of the most recent deficiencies for Las Colinas of Westover. 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? |
|---|---|---|---|---|
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2023-12-23 | 2023-12-24 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-12-23 | 2023-12-24 | Y |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2023-12-11 | 2023-12-12 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-12-11 | 2023-12-12 | 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 | 2023-12-11 | 2023-12-12 | N |
| Conduct testing and exercise requirements. | Fire Safety | 2023-07-27 | 2023-09-06 | N |
| Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. | Health | 2023-07-31 | 2023-08-15 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-07-31 | 2023-08-08 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2023-07-27 | 2023-08-06 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-07-31 | 2023-08-01 | N |
| Employ staff that are licensed, certified, or registered in accordance with state laws. | Health | 2023-07-31 | 2023-08-01 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2023-07-31 | 2023-08-01 | 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 | 2022-11-17 | 2022-11-21 | Y |
| Ensure each resident receives an accurate assessment. | Health | 2022-11-17 | 2022-11-21 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-11-17 | 2022-11-21 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2022-11-17 | 2022-11-21 | Y |
| Employ staff that are licensed, certified, or registered in accordance with state laws. | Health | 2022-11-17 | 2022-11-21 | Y |
| Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | Health | 2022-06-17 | 2022-07-15 | N |
| Keep residents' personal and medical records private and confidential. | Health | 2022-06-17 | 2022-07-15 | N |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2022-06-17 | 2022-07-15 | N |
| Ensure each resident receives an accurate assessment. | Health | 2022-06-17 | 2022-07-15 | N |
| Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. | Health | 2022-06-17 | 2022-07-15 | N |
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2022-06-17 | 2022-07-15 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-06-17 | 2022-07-15 | N |
| Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | Health | 2022-06-17 | 2022-07-15 | 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 | 2022-06-17 | 2022-07-15 | 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 | 2022-06-17 | 2022-07-15 | N |
| Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. | Health | 2022-06-17 | 2022-07-15 | 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 | 2022-06-17 | 2022-07-15 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-06-17 | 2022-07-15 | N |
| Dispose of garbage and refuse properly. | Health | 2022-06-17 | 2022-07-15 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2022-06-17 | 2022-07-15 | N |
| Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. | Health | 2022-06-17 | 2022-07-15 | N |
| Keep all essential equipment working safely. | Health | 2022-06-17 | 2022-07-15 | N |
| Have a battery powered remote alarm panel in a location accessible by operating personnel. | Fire Safety | 2022-06-16 | 2022-07-15 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-06-09 | 2022-07-08 | Y |
| Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident?s advance directives. | Health | 2022-06-09 | 2022-07-08 | Y |
| Employ staff that are licensed, certified, or registered in accordance with state laws. | Health | 2022-06-09 | 2022-07-08 | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2022-06-09 | 2022-07-08 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2021-11-17 | 2021-12-20 | Y |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2021-08-13 | 2021-09-14 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2021-08-13 | 2021-09-14 | Y |
| Respond appropriately to all alleged violations. | Health | 2021-08-13 | 2021-09-14 | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2021-08-13 | 2021-09-14 | Y |
| Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. | Health | 2021-04-20 | 2021-05-14 | Y |
| Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. | Health | 2021-04-09 | 2021-05-07 | 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 | 2021-04-09 | 2021-05-07 | N |
| Keep residents' personal and medical records private and confidential. | Health | 2021-04-09 | 2021-05-07 | 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 | 2021-04-09 | 2021-05-07 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2021-04-09 | 2021-05-07 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2021-04-09 | 2021-05-07 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-04-09 | 2021-05-07 | 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 | 2021-04-09 | 2021-05-07 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2021-04-09 | 2021-05-07 | N |
