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Deficiency Records for Flanagan Rehabilitation and Hcc

A list of the most recent deficiencies for Flanagan Rehabilitation and Hcc. 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 Flanagan Rehabilitation and Hcc. 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?
Inspect, test, and maintain automatic sprinkler systems. Fire Safety 2024-05-08 2024-08-14 N
Honor the resident's right to manage his or her financial affairs. Health 2024-07-03 2024-07-15 Y
Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death. Health 2024-07-03 2024-07-15 Y
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2024-06-12 2024-06-28 Y
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2024-05-08 2024-05-30 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 2024-05-08 2024-05-30 N
Establish staff and initial training requirements. Fire Safety 2024-05-08 2024-05-30 N
Have simulated fire drills held at unexpected times. Fire Safety 2024-05-08 2024-05-30 N
Reasonably accommodate the needs and preferences of each resident. Health 2024-05-08 2024-05-29 N
Have generator or other power source capable of supplying service within 10 seconds. Fire Safety 2024-05-08 2024-05-28 N
Have approved installation, maintenance and testing program for fire alarm systems. Fire Safety 2024-05-08 2024-05-15 N
Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home. Health 2024-05-08 2024-05-13 N
Provide enough food/fluids to maintain a resident's health. Health 2024-05-08 2024-05-13 N
Ensure medication error rates are not 5 percent or greater. Health 2024-05-08 2024-05-13 N
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Health 2024-05-08 2024-05-13 N
Provide and implement an infection prevention and control program. Health 2024-05-08 2024-05-13 N
Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy. Health 2024-03-18 2024-04-26 Y
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Health 2024-01-24 2024-02-20 Y
Respond appropriately to all alleged violations. Health 2024-01-24 2024-02-20 Y
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2024-01-24 2024-02-20 Y
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2024-01-24 2024-02-20 Y
Provide safe and appropriate respiratory care for a resident when needed. Health 2024-01-24 2024-02-20 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 2024-01-24 2024-02-20 Y
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 2024-01-24 2024-02-20 Y
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Health 2024-01-24 2024-02-20 Y
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Health 2024-01-24 2024-02-20 Y
Inspect, test, and maintain automatic sprinkler systems. Fire Safety 2023-07-20 2023-11-29 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 2023-10-24 2023-11-14 Y
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 2023-09-03 2023-11-04 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 2023-09-03 2023-10-17 Y
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2023-09-03 2023-10-17 Y
Have generator or other power source capable of supplying service within 10 seconds. Fire Safety 2023-07-20 2023-09-05 N
Develop and maintain an Emergency Preparedness Program (EP). Fire Safety 2023-07-20 2023-08-12 N
Develop Emergency Preparedness policies and procedures. Fire Safety 2023-07-20 2023-08-12 N
Develop a communication plan. Fire Safety 2023-07-20 2023-08-12 N
Establish emergency prep training and testing. Fire Safety 2023-07-20 2023-08-12 N
Establish staff and initial training requirements. Fire Safety 2023-07-20 2023-08-12 N
Provide properly protected cooking facilities. Fire Safety 2023-07-20 2023-08-12 N
Ensure smoke barriers are constructed to a 1 hour fire resistance rating. Fire Safety 2023-07-20 2023-08-12 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 2023-07-19 2023-08-11 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 2023-07-19 2023-08-11 N
Ensure each resident receives an accurate assessment. Health 2023-07-19 2023-08-11 N
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2023-07-19 2023-08-11 N
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2023-07-19 2023-08-11 N
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2023-07-19 2023-08-11 N
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2023-07-19 2023-08-11 N
Provide safe and appropriate respiratory care for a resident when needed. Health 2023-07-19 2023-08-11 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 2023-07-19 2023-08-11 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 2023-07-19 2023-08-11 N
Ensure medication error rates are not 5 percent or greater. Health 2023-07-19 2023-08-11 N
Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility. Health 2023-07-19 2023-08-11 N
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Health 2023-07-19 2023-08-11 N
Have a plan that describes the process for conducting QAPI and QAA activities. Health 2023-07-19 2023-08-11 N
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Health 2023-07-19 2023-08-11 N
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Health 2023-07-19 2023-08-11 N
Provide and implement an infection prevention and control program. Health 2023-07-19 2023-08-11 N
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. Health 2023-07-19 2023-08-11 N
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2023-03-08 2023-03-27 Y
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 2023-03-08 2023-03-27 Y
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Health 2022-11-30 2022-12-15 Y
Have generator or other power source capable of supplying service within 10 seconds. Fire Safety 2022-06-27 2022-08-15 N
Provide properly protected cooking facilities. Fire Safety 2022-06-27 2022-07-15 N
Have approved installation, maintenance and testing program for fire alarm systems. Fire Safety 2022-06-27 2022-07-15 N
Have simulated fire drills held at unexpected times. Fire Safety 2022-06-27 2022-07-15 N
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. Fire Safety 2022-06-27 2022-07-15 N
Provide for the safe, appropriate administration of IV fluids for a resident when needed. Health 2022-06-09 2022-06-24 N
Provide safe and appropriate respiratory care for a resident when needed. Health 2022-06-09 2022-06-24 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 2022-06-09 2022-06-20 N
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2022-04-05 2022-04-15 Y
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 2022-04-05 2022-04-06 Y
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2022-03-23 2022-04-05 Y
Develop and implement policies and procedures to prevent abuse, neglect, and theft. Health 2022-03-23 2022-04-05 Y
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Health 2022-03-23 2022-04-05 Y
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 2022-03-23 2022-04-05 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2022-01-05 2022-01-13 Y
Ensure that residents are free from significant medication errors. Health 2022-01-05 2022-01-13 Y
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Health 2022-01-05 2022-01-13 Y
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2021-11-04 2021-11-15 Y
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Health 2021-10-07 2021-10-20 Y

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