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Deficiency Records for Brier Oak On Sunset

A list of the most recent deficiencies for Brier Oak On Sunset. The list is based on the information provided by CMS from both standard inspections and from complaints filed by residents.

A list of the most recent deficiencies for Brier Oak On Sunset. 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?
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2024-08-09 2024-08-27 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2024-08-09 2024-08-27 Y
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 2024-06-17 2024-06-20 Y
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2024-04-26 2024-05-02 Y
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Health 2024-02-09 2024-02-27 Y
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Health 2023-12-29 2024-01-26 N
Reasonably accommodate the needs and preferences of each resident. Health 2023-12-29 2024-01-26 N
Ensure residents have reasonable access to and privacy in their use of communication methods. Health 2023-12-29 2024-01-26 N
Notify the resident or the resident?s representative in writing how long the nursing home will hold the resident?s bed in cases of transfer to a hospital or therapeutic leave. Health 2023-12-29 2024-01-26 N
Ensure each resident receives an accurate assessment. Health 2023-12-29 2024-01-26 N
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2023-12-29 2024-01-26 N
Ensure services provided by the nursing facility meet professional standards of quality. Health 2023-12-29 2024-01-26 N
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2023-12-29 2024-01-26 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 2023-12-29 2024-01-26 N
Post nurse staffing information every day. Health 2023-12-29 2024-01-26 N
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Health 2023-12-29 2024-01-26 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 2023-12-29 2024-01-26 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 2023-12-29 2024-01-26 N
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. Health 2023-12-29 2024-01-26 N
Provide and implement an infection prevention and control program. Health 2023-12-29 2024-01-26 N
Keep aisles, corridors, and exits free of obstruction in case of emergency. Fire Safety 2024-01-04 2024-01-26 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 2024-01-04 2024-01-26 N
Have an enclosure around a vertical opening shaft. Fire Safety 2024-01-04 2024-01-26 N
Inspect, test, and maintain automatic sprinkler systems. Fire Safety 2024-01-04 2024-01-26 N
Install corridor and hallway doors that block smoke. Fire Safety 2024-01-04 2024-01-26 N
Ensure smoke barriers are constructed to a 1 hour fire resistance rating. Fire Safety 2024-01-04 2024-01-26 N
Have simulated fire drills held at unexpected times. Fire Safety 2024-01-04 2024-01-26 N
Have proper medical gas storage and administration areas. Fire Safety 2024-01-04 2024-01-26 N
Provide safe and appropriate respiratory care for a resident when needed. Health 2023-10-13 2023-11-12 Y
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2023-08-07 2023-09-06 Y
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Health 2023-08-07 2023-09-06 Y
Ensure each resident?s drug regimen must be free from unnecessary drugs. Health 2023-08-07 2023-09-06 Y
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Health 2023-08-07 2023-09-06 Y
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 2023-08-07 2023-09-06 Y
Provide and implement an infection prevention and control program. Health 2023-08-07 2023-09-06 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2023-05-22 2023-06-21 Y
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Health 2023-04-06 2023-05-02 Y
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 2023-04-06 2023-05-02 Y
Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations and emergencies. Health 2023-04-06 2023-05-02 Y
Provide and implement an infection prevention and control program. Health 2023-04-06 2023-05-02 Y
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Health 2023-03-25 2023-04-25 Y
Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations and emergencies. Health 2023-04-07 2023-04-20 Y
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Health 2023-01-26 2023-02-23 Y
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 2023-02-03 2023-02-21 Y
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. Health 2023-02-08 2023-02-20 Y
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2023-01-22 2023-02-10 Y
Allow residents to self-administer drugs if determined clinically appropriate. Health 2023-01-12 2023-02-09 N
Honor the resident's right to organize and participate in resident/family groups in the facility. Health 2023-01-12 2023-02-09 N
The resident has the right to receive notices in a format and a language he or she understands. Health 2023-01-12 2023-02-09 N
Allow residents to easily view the nursing home's survey results and communicate with advocate agencies. Health 2023-01-12 2023-02-09 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 2023-01-12 2023-02-09 N
Ensure each resident receives an accurate assessment. Health 2023-01-12 2023-02-09 N
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2023-01-12 2023-02-09 N
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2023-01-12 2023-02-09 N
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 2023-01-12 2023-02-09 N
Ensure that residents are free from significant medication errors. Health 2023-01-12 2023-02-09 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 2023-01-12 2023-02-09 N
Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. Health 2023-01-12 2023-02-09 N
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Health 2023-01-12 2023-02-09 N
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2023-01-12 2023-02-09 N
Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations and emergencies. Health 2023-01-12 2023-02-09 N
Provide and implement an infection prevention and control program. Health 2023-01-12 2023-02-09 N
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Health 2023-01-12 2023-02-09 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 2023-01-18 2023-02-09 N
Install emergency lighting that can last at least 1 1/2 hours. Fire Safety 2023-01-18 2023-02-09 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 2023-01-18 2023-02-09 N
Have a fire alarm with audible and visual signals that transmits the alarm automatically to notify emergency forces in event of fire. Fire Safety 2023-01-18 2023-02-09 N
Install an approved automatic sprinkler system. Fire Safety 2023-01-18 2023-02-09 N
Properly install and monitor supervisory attachments on automatic sprinkler systems. Fire Safety 2023-01-18 2023-02-09 N
Properly select, install, inspect, or maintain portable fire extinguishes. Fire Safety 2023-01-18 2023-02-09 N
Ensure smoke barriers are constructed to a 1 hour fire resistance rating. Fire Safety 2023-01-18 2023-02-09 N
Have properly installed electrical wiring and gas equipment. Fire Safety 2023-01-18 2023-02-09 N
To conduct inspection, testing and maintenance of fire doors by qualified individuals. Fire Safety 2023-01-18 2023-02-09 N
Have generator or other power source capable of supplying service within 10 seconds. Fire Safety 2023-01-18 2023-02-09 N
Ensure proper usage of power strips and extension cords. Fire Safety 2023-01-18 2023-02-09 N
Have proper medical gas storage and administration areas. Fire Safety 2023-01-18 2023-02-09 N
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2022-11-28 2022-12-09 Y
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2022-11-03 2022-12-07 Y
Not require residents to give up Medicare or Medicaid benefits, or pay privately as a condition of admission; and must tell residents what care they do not provide. Health 2022-11-03 2022-12-07 Y
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2022-11-03 2022-12-07 Y
Provide safe and appropriate respiratory care for a resident when needed. Health 2022-11-03 2022-12-07 Y
Obtain a doctor's order to admit a resident and ensure the resident is under a doctor's care. Health 2022-11-03 2022-12-07 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 2022-11-03 2022-12-07 Y
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Health 2022-11-03 2022-12-07 Y
Employ or obtain outside professional resources to provide services in the nursing home when the facility does not employ a qualified professional to furnish a required service. Health 2022-11-03 2022-12-07 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 2022-09-29 2022-10-10 Y
Reasonably accommodate the needs and preferences of each resident. Health 2022-09-21 2022-10-10 Y
Provide safe, appropriate pain management for a resident who requires such services. Health 2022-09-21 2022-10-10 Y
Respond appropriately to all alleged violations. Health 2022-09-22 2022-10-07 Y
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Health 2022-09-20 2022-09-30 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2022-08-25 2022-09-19 Y
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2022-08-23 2022-09-16 Y
Respond appropriately to all alleged violations. Health 2022-08-17 2022-09-14 Y
Ensure each resident receives an accurate assessment. Health 2022-08-17 2022-09-14 Y
Ensure each resident must receive and the facility must provide necessary behavioral health care and services. Health 2022-08-17 2022-09-14 Y
Ensure that residents are free from significant medication errors. Health 2022-08-03 2022-09-08 Y
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2022-08-04 2022-08-28 Y
Ensure that each resident is free from medications that restrain them, unless needed for medical treatment. Health 2022-08-02 2022-08-28 Y
Provide and implement an infection prevention and control program. Health 2022-08-02 2022-08-28 Y
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2022-07-16 2022-08-15 Y
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Health 2022-07-02 2022-08-05 Y
Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. Health 2022-06-24 2022-07-29 Y
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Health 2022-05-21 2022-05-27 Y
Provide and implement an infection prevention and control program. Health 2022-05-18 2022-05-27 Y
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 2022-04-25 2022-05-05 Y
Provide and implement an infection prevention and control program. Health 2022-04-05 2022-04-13 Y
Provide or get specialized rehabilitative services as required for a resident. Health 2022-03-04 2022-03-16 Y
Reasonably accommodate the needs and preferences of each resident. Health 2022-02-12 2022-02-28 Y
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2022-02-12 2022-02-28 Y
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Health 2022-01-17 2022-01-31 Y
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2022-01-04 2022-01-28 Y
Address patient/client population and determine types of services needed. Fire Safety 2019-09-18 2019-10-11 N
Provide rooms that can be unlocked from inside without a key. Fire Safety 2019-09-18 2019-10-11 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 2019-09-18 2019-10-11 N
Install proper backup exit lighting. Fire Safety 2019-09-18 2019-10-11 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 2019-09-18 2019-10-11 N
Inspect, test, and maintain automatic sprinkler systems. Fire Safety 2019-09-18 2019-10-11 N
Have simulated fire drills held at unexpected times. Fire Safety 2019-09-18 2019-10-11 N
Have generator or other power source capable of supplying service within 10 seconds. Fire Safety 2019-09-18 2019-10-11 N
Have proper medical gas storage and administration areas. Fire Safety 2019-09-18 2019-10-11 N
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2019-09-10 2019-10-04 N
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 2019-09-10 2019-10-04 N
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Health 2019-09-10 2019-10-04 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 2019-09-10 2019-10-04 N
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2019-09-10 2019-10-04 N
Provide and implement an infection prevention and control program. Health 2019-09-10 2019-10-04 N

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