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Deficiency Records for Menifee Lakes Post Acute

A list of the most recent deficiencies for Menifee Lakes Post Acute. 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 Menifee Lakes Post Acute. 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 safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Health 2024-07-16 2024-07-31 Y
Let each resident or the resident's legal representative access or purchase copies of all the resident's records. Health 2024-06-20 2024-07-07 Y
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2024-02-14 2024-02-22 Y
Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. Health 2023-11-27 2023-12-07 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2023-11-14 2023-12-05 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2023-10-26 2023-11-10 Y
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Health 2023-10-25 2023-11-10 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2023-10-18 2023-10-20 Y
Reasonably accommodate the needs and preferences of each resident. Health 2023-10-17 2023-10-20 Y
Reasonably accommodate the needs and preferences of each resident. Health 2023-09-27 2023-10-06 Y
Provide and implement an infection prevention and control program. Health 2023-08-10 2023-08-30 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 2023-05-18 2023-06-18 N
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. Health 2023-05-18 2023-06-18 N
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted Health 2023-05-18 2023-06-18 N
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2023-05-18 2023-06-18 N
Ensure services provided by the nursing facility meet professional standards of quality. Health 2023-05-18 2023-06-18 N
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2023-05-18 2023-06-18 N
Provide safe, appropriate pain management for a resident who requires such services. Health 2023-05-18 2023-06-18 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 2023-05-18 2023-06-18 N
Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. Health 2023-05-18 2023-06-18 N
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2023-05-18 2023-06-18 N
Let each resident or the resident's legal representative access or purchase copies of all the resident's records. Health 2023-05-25 2023-06-09 Y
Have properly installed hallway dispensers for alcohol-based hand rub. Fire Safety 2023-05-22 2023-06-06 N
Have approved installation, maintenance and testing program for fire alarm systems. Fire Safety 2023-05-22 2023-06-06 N
Have properly installed electrical wiring and gas equipment. Fire Safety 2023-05-22 2023-06-06 N
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. Fire Safety 2023-05-22 2023-06-06 N
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2023-05-15 2023-05-25 Y
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2023-05-09 2023-05-19 Y
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 2023-04-05 2023-05-01 Y
Provide enough food/fluids to maintain a resident's health. Health 2023-04-05 2023-05-01 Y
Develop and implement policies and procedures to prevent abuse, neglect, and theft. Health 2022-12-22 2023-01-12 Y
Provide and implement an infection prevention and control program. Health 2022-09-14 2022-10-04 Y
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Health 2022-09-12 2022-09-23 Y
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2022-09-12 2022-09-23 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 2022-08-26 2022-09-07 Y
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2022-08-18 2022-09-07 Y
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2022-08-11 2022-08-30 Y
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2022-06-14 2022-07-14 Y
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 2022-01-06 2022-02-28 Y
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Health 2022-01-06 2022-02-28 Y
Provide and implement an infection prevention and control program. Health 2021-11-02 2021-12-07 N
Conduct risk assessment and an All-Hazards approach. Fire Safety 2019-11-01 2019-11-19 N
Establish policies and procedures for medical documentation. Fire Safety 2019-11-01 2019-11-19 N
Conduct testing and exercise requirements. Fire Safety 2019-11-01 2019-11-19 N
Use approved construction type or materials. Fire Safety 2019-11-01 2019-11-19 N
Provide properly protected cooking facilities. Fire Safety 2019-11-01 2019-11-19 N
Have approved installation, maintenance and testing program for fire alarm systems. Fire Safety 2019-11-01 2019-11-19 N
Install corridor and hallway doors that block smoke. Fire Safety 2019-11-01 2019-11-19 N
Have generator or other power source capable of supplying service within 10 seconds. Fire Safety 2019-11-01 2019-11-19 N
Have proper medical gas storage and administration areas. Fire Safety 2019-11-01 2019-11-19 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 2019-09-19 2019-10-15 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 2019-09-19 2019-10-15 N
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Health 2019-09-19 2019-10-15 N
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted Health 2019-09-19 2019-10-15 N
Provide activities to meet all resident's needs. Health 2019-09-19 2019-10-15 N
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2019-09-19 2019-10-15 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 2019-09-19 2019-10-15 N
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2019-09-19 2019-10-15 N
Provide and implement an infection prevention and control program. Health 2019-09-19 2019-10-15 N
Include a process for Emergency Preparedness collaboration. Fire Safety 2018-12-20 2019-01-08 N
Develop a communication plan. Fire Safety 2018-12-20 2019-01-08 N
Establish emergency prep training and testing. Fire Safety 2018-12-20 2019-01-08 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 2018-12-20 2019-01-08 N
Provide properly protected cooking facilities. Fire Safety 2018-12-20 2019-01-08 N
Have approved installation, maintenance and testing program for fire alarm systems. Fire Safety 2018-12-20 2019-01-08 N
Install corridor and hallway doors that block smoke. Fire Safety 2018-12-20 2019-01-08 N
Provide properly sized and located linen or trash receptacles. Fire Safety 2018-12-20 2019-01-08 N
Ensure proper usage of power strips and extension cords. Fire Safety 2018-12-20 2019-01-08 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 2018-10-19 2018-11-26 N
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Health 2018-10-19 2018-11-26 N
Ensure each resident receives an accurate assessment. Health 2018-10-19 2018-11-26 N
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2018-10-19 2018-11-26 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 2018-10-19 2018-11-26 N
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2018-10-19 2018-11-26 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 2018-10-19 2018-11-26 N
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Health 2018-10-19 2018-11-26 N
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. Health 2018-10-19 2018-11-26 N
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2018-10-19 2018-11-26 N
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Health 2018-10-19 2018-11-26 N

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