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Deficiency Records for Sullivan Rehab and Hlth Care Ctr
A list of the most recent deficiencies for Sullivan Rehab and Hlth Care Ctr. 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 Sullivan Rehab and Hlth Care Ctr. 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? |
|---|---|---|---|---|
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2024-09-11 | 2024-10-01 | 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 | 2024-09-11 | 2024-10-01 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2024-09-11 | 2024-10-01 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2024-09-11 | 2024-10-01 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2024-09-11 | 2024-10-01 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2024-09-11 | 2024-10-01 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2024-09-11 | 2024-10-01 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2024-09-11 | 2024-10-01 | N |
| Give residents a notice of rights, rules, services and charges. | Health | 2024-09-13 | 2024-09-30 | N |
| Ensure residents have reasonable access to and privacy in their use of communication methods. | Health | 2024-09-13 | 2024-09-30 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2024-09-13 | 2024-09-30 | 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 | 2024-09-13 | 2024-09-30 | N |
| Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | Health | 2024-09-13 | 2024-09-30 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2024-09-13 | 2024-09-30 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2024-09-13 | 2024-09-30 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2024-09-13 | 2024-09-30 | N |
| Ensure that residents are free from significant medication errors. | Health | 2024-09-13 | 2024-09-30 | N |
| Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. | Health | 2024-09-13 | 2024-09-30 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2024-09-13 | 2024-09-30 | N |
| Provide and implement an infection prevention and control program. | Health | 2024-09-13 | 2024-09-30 | N |
| Provide or get specialized rehabilitative services as required for a resident. | Health | 2024-03-19 | 2024-04-05 | Y |
| Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. | Health | 2023-08-04 | 2023-08-23 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-08-04 | 2023-08-23 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-08-04 | 2023-08-22 | N |
| Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. | Health | 2023-08-04 | 2023-08-22 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-08-04 | 2023-08-21 | N |
| PASARR screening for Mental disorders or Intellectual Disabilities | Health | 2023-08-04 | 2023-08-18 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2023-08-04 | 2023-08-18 | N |
| Establish roles under a Waiver declared by secretary. | Fire Safety | 2023-08-01 | 2023-08-16 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-08-01 | 2023-08-16 | N |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-07-14 | 2023-08-03 | Y |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2023-07-14 | 2023-08-03 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2023-04-06 | 2023-04-23 | Y |
| Ensure that nurse aides who have worked more than 4 months, are trained and competent; and nurse aides who have worked less than 4 months are enrolled in appropriate training. | Health | 2023-04-06 | 2023-04-23 | Y |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2022-10-05 | 2022-10-25 | N |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2022-09-02 | 2022-09-19 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-09-02 | 2022-09-19 | N |
| Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. | Health | 2022-09-02 | 2022-09-19 | N |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2022-01-04 | 2022-01-19 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2021-11-18 | 2021-12-01 | Y |
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