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Deficiency Records for Belleville Healthcare and Rehabilitation Center
A list of the most recent deficiencies for Belleville Healthcare and Rehabilitation 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 Belleville Healthcare and Rehabilitation 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? |
|---|---|---|---|---|
| Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2024-03-05 | 2024-05-10 | N |
| Conduct testing and exercise requirements. | Fire Safety | 2024-03-05 | 2024-05-10 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2024-03-05 | 2024-05-10 | N |
| Have properly located and lighted "Exit" signs. | Fire Safety | 2024-03-05 | 2024-05-10 | 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 | 2024-03-05 | 2024-05-10 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2024-03-05 | 2024-05-10 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2024-03-05 | 2024-05-10 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2024-03-05 | 2024-05-10 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2024-03-05 | 2024-05-10 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2024-03-05 | 2024-05-10 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2024-03-05 | 2024-05-10 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2024-03-05 | 2024-05-10 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2024-03-05 | 2024-05-10 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2024-03-05 | 2024-05-10 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2024-03-05 | 2024-05-06 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2024-02-05 | 2024-03-16 | 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 | 2024-02-05 | 2024-03-16 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2024-02-05 | 2024-03-16 | 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 | 2024-02-05 | 2024-03-16 | Y |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2024-02-05 | 2024-03-16 | Y |
| Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | Health | 2024-02-05 | 2024-03-16 | Y |
| Provide and implement an infection prevention and control program. | Health | 2024-02-05 | 2024-03-16 | Y |
| Keep all essential equipment working safely. | Health | 2024-02-05 | 2024-03-16 | Y |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-08-29 | 2023-09-22 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2023-08-29 | 2023-09-22 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-04-19 | 2023-04-17 | Y |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2022-10-27 | 2022-11-08 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-10-27 | 2022-11-08 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2022-10-27 | 2022-11-08 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2022-10-27 | 2022-11-08 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2022-10-27 | 2022-11-08 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2022-10-27 | 2022-11-08 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2022-10-27 | 2022-11-08 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2022-10-27 | 2022-11-08 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2022-10-27 | 2022-10-27 | 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 | 2022-09-26 | 2022-10-19 | Y |
| 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 | 2022-09-26 | 2022-10-19 | Y |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-09-26 | 2022-10-19 | Y |
| Provide and implement an infection prevention and control program. | Health | 2022-09-26 | 2022-10-19 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-03-29 | 2022-03-15 | Y |
| Conduct testing and exercise requirements. | Fire Safety | 2021-08-25 | 2021-09-20 | 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 | 2021-08-25 | 2021-09-20 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2021-08-25 | 2021-09-20 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2021-08-25 | 2021-09-20 | N |
| Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2021-08-25 | 2021-09-20 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2021-08-25 | 2021-09-20 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2021-08-25 | 2021-09-20 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2021-08-25 | 2021-09-20 | N |
| Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk. | Fire Safety | 2021-08-25 | 2021-09-20 | N |
| Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. | Health | 2021-07-19 | 2021-09-01 | 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 | 2021-07-19 | 2021-07-30 | 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 | 2021-07-19 | 2021-07-29 | N |
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2021-07-19 | 2021-07-24 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2021-07-19 | 2021-07-24 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2021-07-19 | 2021-07-23 | 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 | 2021-07-19 | 2021-07-23 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2021-07-19 | 2021-07-23 | 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 | 2021-07-19 | 2021-07-23 | N |
| Post nurse staffing information every day. | Health | 2021-07-19 | 2021-07-22 | N |
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