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Deficiency Records for Midway Neurological / Rehab Center
A list of the most recent deficiencies for Midway Neurological / Rehab Center. 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 Midway Neurological / Rehab Center. 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? |
|---|---|---|---|---|
| Establish policies and procedures for volunteers. | Fire Safety | 2024-07-18 | 2024-09-05 | N |
| Establish staff and initial training requirements. | Fire Safety | 2024-07-18 | 2024-09-05 | N |
| Conduct risk assessment and an All-Hazards approach. | Fire Safety | 2024-07-18 | 2024-09-02 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2024-07-18 | 2024-08-30 | N |
| Have elevators that firefighters can control in the event of a fire. | Fire Safety | 2024-07-18 | 2024-08-23 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2024-07-18 | 2024-08-16 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2024-07-18 | 2024-08-05 | 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 | 2024-07-18 | 2024-08-05 | 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 | 2024-07-18 | 2024-08-05 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2024-07-18 | 2024-08-05 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2024-07-18 | 2024-08-02 | N |
| Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke. | Fire Safety | 2024-07-18 | 2024-08-02 | N |
| Ensure precautions for handling oxygen cylinders and equipment are correctly followed. | Fire Safety | 2024-07-18 | 2024-08-01 | 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 | 2024-07-17 | 2024-07-24 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2024-07-17 | 2024-07-24 | N |
| Have an enclosure around a vertical opening shaft. | Fire Safety | 2024-07-18 | 2024-07-22 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2024-07-18 | 2024-07-19 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2024-07-18 | 2024-07-19 | N |
| Ensure proper storage of liquid oxygen. | Fire Safety | 2024-07-18 | 2024-07-19 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2024-07-18 | 2024-07-18 | N |
| Have restrictions on the use of portable space heaters. | Fire Safety | 2024-07-18 | 2024-07-18 | N |
| Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. | Health | 2024-06-27 | 2024-07-10 | 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 | 2024-06-27 | 2024-07-10 | Y |
| Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made. | Health | 2024-05-03 | 2024-05-23 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2024-05-03 | 2024-05-23 | Y |
| Protect each resident from the wrongful use of the resident's belongings or money. | Health | 2024-05-03 | 2024-05-23 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2024-05-03 | 2024-05-23 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2024-05-03 | 2024-05-23 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2024-05-03 | 2024-05-23 | Y |
| Provide enough food/fluids to maintain a resident's health. | Health | 2024-05-03 | 2024-05-23 | Y |
| Use approved construction type or materials. | Fire Safety | 2023-09-27 | 2023-12-15 | N |
| Ensure each resident must receive and the facility must provide necessary behavioral health care and services. | Health | 2023-09-29 | 2023-10-25 | 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 | 2023-09-29 | 2023-10-23 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2023-09-29 | 2023-10-23 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-09-29 | 2023-10-23 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-09-29 | 2023-10-23 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2023-09-29 | 2023-10-23 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-09-29 | 2023-10-23 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2023-09-29 | 2023-10-23 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-09-29 | 2023-10-23 | 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 | 2023-09-27 | 2023-10-23 | 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 | 2023-09-27 | 2023-10-23 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2023-09-27 | 2023-10-23 | N |
| Have an enclosure around a vertical opening shaft. | Fire Safety | 2023-09-27 | 2023-10-23 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2023-09-27 | 2023-10-23 | N |
| Have properly installed hallway dispensers for alcohol-based hand rub. | Fire Safety | 2023-09-27 | 2023-10-23 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2023-09-27 | 2023-10-23 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-09-27 | 2023-10-23 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2023-09-27 | 2023-10-23 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2023-09-27 | 2023-10-23 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2023-09-27 | 2023-10-23 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2023-09-27 | 2023-10-23 | N |
| Install properly constructed and protected linen or trash chutes. | Fire Safety | 2023-09-27 | 2023-10-23 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2023-09-27 | 2023-10-23 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2023-09-27 | 2023-10-23 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2023-09-27 | 2023-10-23 | N |
| Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. | Health | 2023-05-09 | 2023-05-26 | Y |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2023-04-14 | 2023-04-25 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-04-14 | 2023-04-25 | Y |
| Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. | Health | 2023-04-14 | 2023-04-25 | Y |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2023-04-14 | 2023-04-25 | Y |
| Install an approved automatic sprinkler system. | Fire Safety | 2022-09-13 | 2023-03-21 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-09-13 | 2023-03-21 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2022-09-13 | 2022-12-20 | N |
| Have elevators that firefighters can control in the event of a fire. | Fire Safety | 2022-09-13 | 2022-11-30 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2022-08-19 | 2022-11-05 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2022-08-19 | 2022-11-05 | Y |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2022-09-13 | 2022-10-31 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2022-09-13 | 2022-10-19 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2022-09-13 | 2022-10-19 | N |
| Provide a written emergency evacuation plan. | Fire Safety | 2022-09-13 | 2022-10-19 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2022-09-13 | 2022-10-19 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2022-09-13 | 2022-10-19 | N |
| Ensure precautions for handling oxygen cylinders and equipment are correctly followed. | Fire Safety | 2022-09-13 | 2022-10-19 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2022-09-13 | 2022-10-18 | 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 | 2022-09-13 | 2022-10-18 | N |
| Have an enclosure around a vertical opening shaft. | Fire Safety | 2022-09-13 | 2022-10-18 | 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 | 2022-09-13 | 2022-10-18 | N |
| Address patient/client population and determine types of services needed. | Fire Safety | 2022-09-13 | 2022-10-17 | N |
| Address subsistence needs for staff and patients. | Fire Safety | 2022-09-13 | 2022-10-17 | N |
| Establish policies and procedures for medical documentation. | Fire Safety | 2022-09-13 | 2022-10-17 | N |
| Create arrangements with other facilities to receive patients. | Fire Safety | 2022-09-13 | 2022-10-17 | N |
| List the names and contact information of those in the facility. | Fire Safety | 2022-09-13 | 2022-10-17 | N |
| Establish staff and initial training requirements. | Fire Safety | 2022-09-13 | 2022-10-17 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2022-08-19 | 2022-09-02 | 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 | 2022-08-19 | 2022-09-02 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2022-08-19 | 2022-09-02 | N |
| Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. | Health | 2022-08-19 | 2022-09-02 | N |
| Provide safe, appropriate pain management for a resident who requires such services. | Health | 2022-08-19 | 2022-09-02 | 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 | 2022-08-19 | 2022-09-02 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-08-19 | 2022-09-02 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2022-08-19 | 2022-09-02 | Y |
| Protect each resident from separation (from other residents, his/her room, or confinement to his/her room). | Health | 2022-08-19 | 2022-09-02 | Y |
| Make sure that a working call system is available in each resident's bathroom and bathing area. | Health | 2022-08-19 | 2022-09-02 | Y |
| Give the resident's representative the ability to exercise the resident's rights. | Health | 2022-05-11 | 2022-06-03 | Y |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2022-05-11 | 2022-06-03 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2022-05-11 | 2022-06-03 | Y |
| Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | Health | 2022-05-11 | 2022-06-03 | Y |
| Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. | Health | 2022-05-11 | 2022-06-03 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-05-11 | 2022-06-03 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-05-11 | 2022-06-03 | 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 | 2022-05-11 | 2022-06-03 | Y |
| Provide or obtain x-rays/tests when ordered and promptly tell the ordering practitioner of the results. | Health | 2022-05-11 | 2022-06-03 | Y |
| Make sure that a working call system is available in each resident's bathroom and bathing area. | Health | 2022-05-11 | 2022-06-03 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2021-12-10 | 2022-01-02 | Y |
| Protect each resident from separation (from other residents, his/her room, or confinement to his/her room). | Health | 2021-12-10 | 2022-01-02 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2021-12-10 | 2022-01-02 | Y |
| Respond appropriately to all alleged violations. | Health | 2021-12-10 | 2022-01-02 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2021-12-10 | 2022-01-02 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-12-10 | 2022-01-02 | Y |
| Provide safe, appropriate pain management for a resident who requires such services. | Health | 2021-12-10 | 2022-01-02 | Y |
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