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Deficiency Records for Hillcrest Health Care Center
A list of the most recent deficiencies for Hillcrest Health Care 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 Hillcrest Health Care 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? |
|---|---|---|---|---|
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2024-07-28 | 2024-08-13 | Y |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2024-07-28 | 2024-08-13 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2024-07-28 | 2024-08-13 | 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 | 2024-07-28 | 2024-08-13 | 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 | 2024-07-28 | 2024-08-13 | 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 | 2024-07-28 | 2024-08-13 | Y |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2024-07-28 | 2024-08-13 | Y |
| Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. | Health | 2024-07-28 | 2024-08-13 | Y |
| Ensure meals and snacks are served at times in accordance with resident?s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. | Health | 2024-07-28 | 2024-08-13 | Y |
| Provide and implement an infection prevention and control program. | Health | 2024-07-28 | 2024-08-13 | Y |
| Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. | Health | 2024-07-28 | 2024-08-07 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2024-01-31 | 2024-02-14 | 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 | 2024-01-31 | 2024-02-14 | 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 | 2024-01-31 | 2024-02-14 | N |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2024-01-31 | 2024-02-14 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2024-01-31 | 2024-02-14 | 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 | 2024-01-31 | 2024-02-14 | N |
| Ensure each resident receives an accurate assessment. | Health | 2024-01-31 | 2024-02-14 | N |
| Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. | Health | 2024-01-31 | 2024-02-14 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2024-01-31 | 2024-02-14 | N |
| Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | Health | 2024-01-31 | 2024-02-14 | 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 | 2024-01-31 | 2024-02-14 | N |
| Ensure that residents are free from significant medication errors. | Health | 2024-01-31 | 2024-02-14 | N |
| Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. | Health | 2024-01-31 | 2024-02-14 | 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 | 2024-01-31 | 2024-02-14 | N |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2024-01-31 | 2024-02-14 | N |
| Ensure meals and snacks are served at times in accordance with resident?s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. | Health | 2024-01-31 | 2024-02-14 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2024-01-31 | 2024-02-14 | N |
| Have a plan that describes the process for conducting QAPI and QAA activities. | Health | 2024-01-31 | 2024-02-14 | N |
| Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | Health | 2024-01-31 | 2024-02-14 | N |
| Provide and implement an infection prevention and control program. | Health | 2024-01-31 | 2024-02-14 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2024-01-31 | 2024-02-14 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2024-01-31 | 2024-02-14 | Y |
| 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 | 2024-01-31 | 2024-02-14 | Y |
| Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. | Health | 2024-01-31 | 2024-02-08 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2024-01-29 | 2024-02-06 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2024-01-29 | 2024-02-05 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2024-01-29 | 2024-02-02 | N |
| Have restrictions on the use of highly flammable decorations. | Fire Safety | 2024-01-29 | 2024-02-02 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2024-01-29 | 2024-01-30 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2024-01-29 | 2024-01-29 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-08-17 | 2023-06-14 | Y |
| Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | Health | 2022-11-10 | 2022-12-10 | N |
| 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 | 2022-11-10 | 2022-12-10 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-11-10 | 2022-12-10 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-11-10 | 2022-12-10 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2022-11-10 | 2022-12-10 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2022-11-10 | 2022-12-10 | 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 | 2022-11-10 | 2022-12-10 | Y |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2022-11-10 | 2022-12-10 | Y |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2022-11-07 | 2022-12-07 | 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 | 2022-11-07 | 2022-12-07 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2022-11-07 | 2022-12-07 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2022-11-07 | 2022-12-07 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2022-11-07 | 2022-11-15 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-11-07 | 2022-11-14 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2022-11-07 | 2022-11-14 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2022-09-27 | 2022-10-27 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-09-27 | 2022-10-27 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-09-27 | 2022-10-27 | 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 | 2022-09-27 | 2022-10-27 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-09-27 | 2022-10-12 | Y |
| Conduct testing and exercise requirements. | Fire Safety | 2021-06-11 | 2021-08-17 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2021-06-15 | 2021-07-14 | 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 | 2021-06-15 | 2021-07-14 | N |
| 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 | 2021-06-15 | 2021-07-14 | N |
| Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | Health | 2021-06-15 | 2021-07-14 | N |
| Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. | Health | 2021-06-15 | 2021-07-14 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2021-06-15 | 2021-07-14 | N |
| Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | Health | 2021-06-15 | 2021-07-14 | N |
| Provide and implement an infection prevention and control program. | Health | 2021-06-15 | 2021-07-14 | N |
| Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2021-06-11 | 2021-07-11 | N |
| Develop a communication plan. | Fire Safety | 2021-06-11 | 2021-07-11 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2021-06-11 | 2021-07-11 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2021-06-11 | 2021-07-11 | 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 | 2021-06-11 | 2021-06-28 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2021-06-11 | 2021-06-28 | N |
| Have restrictions on the use of flammable curtains. | Fire Safety | 2021-06-11 | 2021-06-25 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2021-06-11 | 2021-06-24 | N |
| Conduct risk assessment and an All-Hazards approach. | Fire Safety | 2021-06-11 | 2021-06-21 | N |
| Establish procedures for tracking staff and patients during an emergency. | Fire Safety | 2021-06-11 | 2021-06-21 | N |
| Establish policies and procedures for medical documentation. | Fire Safety | 2021-06-11 | 2021-06-21 | N |
| Establish roles under a Waiver declared by secretary. | Fire Safety | 2021-06-11 | 2021-06-21 | N |
| Provide emergency officials' contact information. | Fire Safety | 2021-06-11 | 2021-06-21 | N |
| Establish methods for sharing information. | Fire Safety | 2021-06-11 | 2021-06-21 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2021-06-11 | 2021-06-14 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2021-06-11 | 2021-06-14 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2021-06-11 | 2021-06-14 | N |
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