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Deficiency Records for Elizabeth Seton

A list of the most recent deficiencies for Elizabeth Seton. 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 Elizabeth Seton. 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 implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2023-08-31 2023-09-28 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 2023-08-31 2023-09-28 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 2023-08-31 2023-09-28 N
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Health 2023-08-31 2023-09-28 N
Meet requirements for sections of health care facilities separated by fire resistive construction. Fire Safety 2022-08-26 2022-10-20 N
Install noncombustible or limited-combustible interior walls. Fire Safety 2022-08-26 2022-10-20 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 2022-08-26 2022-10-20 N
Have approved installation, maintenance and testing program for fire alarm systems. Fire Safety 2022-08-26 2022-10-20 N
Inspect, test, and maintain automatic sprinkler systems. Fire Safety 2022-08-26 2022-10-20 N
Meet requirements for the installation and maintenance of electrical systems. Fire Safety 2022-08-26 2022-10-20 N
Install emergency lighting that can last at least 1 1/2 hours. Fire Safety 2022-08-26 2022-09-30 N
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. Health 2022-08-17 2022-09-19 N
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2022-08-17 2022-09-19 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 2022-08-17 2022-09-19 N
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2022-08-17 2022-09-19 N
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Health 2022-08-17 2022-09-19 N
Have properly located and lighted "Exit" signs. Fire Safety 2022-08-26 2022-09-16 N
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2019-10-04 2019-11-16 N

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