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Deficiency Records for Westgate Hills Rehab and Healthcare Ctr

A list of the most recent deficiencies for Westgate Hills Rehab and Healthcare Ctr. 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 Westgate Hills Rehab and Healthcare Ctr. 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?
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Health 2021-12-28 2022-02-11 N
Prepare residents for a safe transfer or discharge from the nursing home. Health 2021-12-28 2022-02-11 N
Keep aisles, corridors, and exits free of obstruction in case of emergency. Fire Safety 2020-08-28 2020-09-25 N
Have stairways and smokeproof enclosures used as exits that meet safety requirements. Fire Safety 2020-08-28 2020-09-25 N
Install corridor and hallway doors that block smoke. Fire Safety 2020-08-28 2020-09-25 N
To conduct inspection, testing and maintenance of fire doors by qualified individuals. Fire Safety 2020-08-28 2020-09-25 N
Reasonably accommodate the needs and preferences of each resident. Health 2020-02-28 2020-03-31 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 2020-02-28 2020-03-31 N
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Health 2020-02-28 2020-03-31 N
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. Health 2020-02-28 2020-03-31 N
Ensure each resident receives an accurate assessment. Health 2020-02-28 2020-03-31 N
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted Health 2020-02-28 2020-03-31 N
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2020-02-28 2020-03-31 N
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2020-02-28 2020-03-31 N
Provide enough food/fluids to maintain a resident's health. Health 2020-02-28 2020-03-31 N
Provide safe, appropriate pain management for a resident who requires such services. Health 2020-02-28 2020-03-31 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 2020-02-28 2020-03-31 N
Post nurse staffing information every day. Health 2020-02-28 2020-03-31 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 2020-02-28 2020-03-31 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 2020-02-28 2020-03-31 N
Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations and emergencies. Health 2020-02-28 2020-03-31 N
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Health 2020-02-28 2020-03-31 N
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Health 2020-02-28 2020-03-31 N
Meet other general requirements. Fire Safety 2018-10-29 2018-12-03 N
Keep aisles, corridors, and exits free of obstruction in case of emergency. Fire Safety 2018-10-29 2018-12-03 N
Have stairways and smokeproof enclosures used as exits that meet safety requirements. Fire Safety 2018-10-29 2018-12-03 N
Install proper backup exit lighting. Fire Safety 2018-10-29 2018-12-03 N
Have properly installed electrical wiring and gas equipment. Fire Safety 2018-10-29 2018-12-03 N
Have generator or other power source capable of supplying service within 10 seconds. Fire Safety 2018-10-29 2018-12-03 N
Have proper medical gas storage and administration areas. Fire Safety 2018-10-29 2018-12-03 N
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. Health 2018-08-09 2018-09-18 N
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Health 2018-08-09 2018-09-18 N
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2018-08-09 2018-09-18 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 2018-08-09 2018-09-18 N
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2018-08-09 2018-09-18 N
Assist a resident in gaining access to vision and hearing services. Health 2018-08-09 2018-09-18 N
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2018-08-09 2018-09-18 N
Provide appropriate foot care. Health 2018-08-09 2018-09-18 N
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2018-08-09 2018-09-18 N
Provide enough food/fluids to maintain a resident's health. Health 2018-08-09 2018-09-18 N
Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. Health 2018-08-09 2018-09-18 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 2018-08-09 2018-09-18 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 2018-08-09 2018-09-18 N
Provide timely, quality laboratory services/tests to meet the needs of residents. Health 2018-08-09 2018-09-18 N
Provide or obtain dental services for each resident. Health 2018-08-09 2018-09-18 N
Provide or get specialized rehabilitative services as required for a resident. Health 2018-08-09 2018-09-18 N
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Health 2018-08-09 2018-09-18 N
Give residents a notice of rights, rules, services and charges. Health 2017-05-26 2017-07-25 N
Protect each resident from all abuse, physical punishment, and involuntary separation from others. Health 2017-05-26 2017-07-25 N
1) Hire only people with no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents. Health 2017-05-26 2017-07-25 N
Provide care for residents in a way that maintains or improves their dignity and respect in full recognition of their individuality. Health 2017-05-26 2017-07-25 N
Ensure residents have the right to have a choice over activities, their schedules, and health care according to their interests, assessments, and plans of care. Health 2017-05-26 2017-07-25 N
Conduct initial and periodic assessments of each resident's functional capacity. Health 2017-05-26 2017-07-25 N
Provide necessary care and services to maintain or improve the highest well being of each resident . Health 2017-05-26 2017-07-25 N
Ensure that each resident's 1) entire drug/medication regimen is free from unnecessary drugs; and 2) is managed and monitored to achieve highest level of well-being. Health 2017-05-26 2017-07-25 N
Ensure that residents are safe from serious medication errors. Health 2017-05-26 2017-07-25 N
Store, cook, and serve food in a safe and clean way. Health 2017-05-26 2017-07-25 N
At least once a month, have a licensed pharmacist review each resident's medication(s) and report any irregularities to the attending doctor. Health 2017-05-26 2017-07-25 N
Maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards. Health 2017-05-26 2017-07-25 N
Have a program that investigates, controls and keeps infection from spreading. Health 2017-05-26 2017-07-25 N
Employ or obtain outside professional resources to provide services in the nursing home when the facility does not employ a qualified professional to furnish a required service. Health 2017-05-26 2017-07-25 N
Give or get quality laboratory services/tests in a timely manner to meet the needs of residents. Health 2017-05-26 2017-07-25 N
Provide or obtain laboratory services only when ordered by the attending physician. Health 2017-05-26 2017-07-25 N
Quickly tell the resident's doctor the results of laboratory tests. Health 2017-05-26 2017-07-25 N
Give or get x-rays and other tests in a timely manner to meet the needs of residents. Health 2017-05-26 2017-07-25 N
Tell the attending physician the results of x-rays and other tests, in a timely manner. Health 2017-05-26 2017-07-25 N
Have a detailed, written plan for disasters and emergencies, such as fire, severe weather, and missing residents. Health 2017-05-26 2017-07-25 N

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