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Deficiency Records for Evangeline Oaks Guest House
A list of the most recent deficiencies for Evangeline Oaks Guest House. 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 Evangeline Oaks Guest House. 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? |
---|---|---|---|---|
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2024-06-25 | 2024-07-19 | Y |
Honor the resident's right to organize and participate in resident/family groups in the facility. | Health | 2024-05-22 | 2024-06-07 | N |
Ensure each resident receives an accurate assessment. | Health | 2024-05-22 | 2024-06-07 | 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 | 2024-05-22 | 2024-06-07 | N |
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2024-05-22 | 2024-06-07 | N |
Provide and implement an infection prevention and control program. | Health | 2024-05-22 | 2024-06-07 | N |
Make sure that a working call system is available in each resident's bathroom and bathing area. | Health | 2024-05-22 | 2024-06-07 | N |
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2024-05-22 | 2024-06-07 | Y |
Ensure residents have reasonable access to and privacy in their use of communication methods. | Health | 2024-05-22 | 2024-06-07 | 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 | 2024-05-22 | 2024-06-07 | Y |
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2024-05-22 | 2024-06-07 | Y |
Provide activities to meet all resident's needs. | Health | 2024-05-22 | 2024-06-07 | 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 | 2024-05-22 | 2024-06-07 | Y |
Ensure medication error rates are not 5 percent or greater. | Health | 2024-05-22 | 2024-06-07 | Y |
Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data. | Health | 2024-05-22 | 2024-06-07 | Y |
Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. | Health | 2024-04-16 | 2024-05-31 | 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 | 2024-04-16 | 2024-05-31 | 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 | 2024-04-16 | 2024-05-31 | Y |
Provide and implement an infection prevention and control program. | Health | 2024-04-16 | 2024-05-31 | Y |
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2024-01-04 | 2024-02-16 | Y |
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 | 2023-06-21 | 2023-08-05 | Y |
PASARR screening for Mental disorders or Intellectual Disabilities | Health | 2023-06-21 | 2023-08-05 | N |
Provide activities to meet all resident's needs. | Health | 2023-06-21 | 2023-08-05 | N |
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. | Health | 2023-06-21 | 2023-08-05 | N |
Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-06-21 | 2023-08-05 | N |
Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2023-06-21 | 2023-08-05 | 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 | 2023-06-21 | 2023-08-05 | N |
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-06-21 | 2023-08-05 | N |
Provide and implement an infection prevention and control program. | Health | 2023-06-21 | 2023-08-05 | N |
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. | Health | 2023-06-21 | 2023-08-05 | N |
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2023-06-21 | 2023-08-05 | N |
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2023-06-21 | 2023-08-05 | Y |
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2023-06-21 | 2023-08-05 | Y |
Respond appropriately to all alleged violations. | Health | 2023-06-21 | 2023-08-05 | Y |
Ensure each resident receives an accurate assessment. | Health | 2023-06-21 | 2023-08-05 | Y |
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-06-21 | 2023-08-05 | Y |
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. | Fire Safety | 2023-06-20 | 2023-08-05 | N |
Have power receptacles that are properly grounded. | Fire Safety | 2023-06-20 | 2023-08-05 | N |
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2022-11-29 | 2023-01-06 | Y |
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. | Health | 2022-05-11 | 2022-06-24 | N |
Provide enough food/fluids to maintain a resident's health. | Health | 2022-05-11 | 2022-06-24 | 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 | 2022-05-11 | 2022-06-24 | 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 | 2022-01-05 | 2022-02-19 | Y |
Ensure that residents are free from significant medication errors. | Health | 2022-01-05 | 2022-02-19 | 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 | 2022-02-19 | Y |
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