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Deficiency Records for Sabetha Manor
A list of the most recent deficiencies for Sabetha Manor. 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 Sabetha Manor. 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? |
|---|---|---|---|---|
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2024-07-02 | 2024-07-23 | 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 | 2024-04-16 | 2024-05-01 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2024-04-16 | 2024-05-01 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2024-04-16 | 2024-05-01 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2024-04-16 | 2024-05-01 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2024-04-16 | 2024-05-01 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2024-03-20 | 2024-04-20 | Y |
| 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 | 2024-03-20 | 2024-04-20 | 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 | 2024-03-20 | 2024-04-20 | 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 | 2024-03-20 | 2024-04-20 | Y |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2024-03-20 | 2024-04-20 | Y |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2024-03-20 | 2024-04-20 | Y |
| Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data. | Health | 2024-03-20 | 2024-04-20 | Y |
| Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | Health | 2024-03-20 | 2024-04-20 | Y |
| Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. | Health | 2024-03-20 | 2024-04-20 | Y |
| Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2022-12-06 | 2022-12-15 | N |
| Meet other general requirements. | Fire Safety | 2022-12-06 | 2022-12-15 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2022-12-06 | 2022-12-15 | N |
| Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2022-12-06 | 2022-12-15 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2022-12-06 | 2022-12-15 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2022-12-06 | 2022-12-15 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2022-12-06 | 2022-12-15 | N |
| Ensure that building systems meet requirements determined by risk assessment procedures performed by qualified personnel. | Fire Safety | 2022-12-06 | 2022-12-15 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-12-06 | 2022-12-08 | 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 | 2022-11-15 | 2022-12-01 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-11-15 | 2022-12-01 | N |
| Use approved construction type or materials. | Fire Safety | 2021-06-22 | 2021-06-28 | 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 | 2021-06-22 | 2021-06-28 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2021-06-22 | 2021-06-28 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2021-06-22 | 2021-06-28 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2021-06-22 | 2021-06-28 | N |
| Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | Health | 2021-06-09 | 2021-06-21 | N |
| Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | Health | 2021-06-09 | 2021-06-21 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2021-06-09 | 2021-06-21 | 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 | 2021-06-09 | 2021-06-21 | 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 | 2021-06-09 | 2021-06-21 | N |
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