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Deficiency Records for West Newton Healthcare
A list of the most recent deficiencies for West Newton Healthcare. 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 West Newton Healthcare. 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 appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2024-02-02 | 2024-05-06 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2024-02-02 | 2024-05-06 | 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 | 2024-02-02 | 2024-05-06 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2024-02-02 | 2024-05-06 | N |
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2024-02-02 | 2024-03-22 | N |
| Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | Health | 2024-02-02 | 2024-03-22 | N |
| Ensure each resident must receive and the facility must provide necessary behavioral health care and services. | Health | 2024-02-02 | 2024-03-22 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2024-02-02 | 2024-03-22 | N |
| Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. | Health | 2024-02-02 | 2024-03-22 | N |
| Address patient/client population and determine types of services needed. | Fire Safety | 2024-02-20 | 2024-03-09 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2024-02-20 | 2024-03-09 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2024-02-20 | 2024-03-09 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2024-02-02 | 2024-03-08 | N |
| Ensure that residents are fully informed and understand their health status, care and treatments. | Health | 2024-02-02 | 2024-03-08 | N |
| Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | Health | 2024-02-02 | 2024-03-08 | 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 | 2024-02-02 | 2024-03-08 | N |
| Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. | Health | 2024-02-02 | 2024-03-08 | N |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2024-02-02 | 2024-03-08 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2024-02-02 | 2024-03-08 | N |
| 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 | 2024-02-02 | 2024-03-08 | N |
| PASARR screening for Mental disorders or Intellectual Disabilities | Health | 2024-02-02 | 2024-03-08 | N |
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2024-02-02 | 2024-03-08 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2024-02-02 | 2024-03-08 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2024-02-02 | 2024-03-08 | N |
| Provide activities to meet all resident's needs. | Health | 2024-02-02 | 2024-03-08 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2024-02-02 | 2024-03-08 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2024-02-02 | 2024-03-08 | N |
| Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. | Health | 2024-02-02 | 2024-03-08 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2024-02-02 | 2024-03-08 | N |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2024-02-02 | 2024-03-08 | N |
| Provide care or services that was trauma informed and/or culturally competent. | Health | 2024-02-02 | 2024-03-08 | 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 | 2024-02-02 | 2024-03-08 | N |
| Observe each nurse aide's job performance and give regular training. | Health | 2024-02-02 | 2024-03-08 | N |
| Provide medically-related social services to help each resident achieve the highest possible quality of life. | Health | 2024-02-02 | 2024-03-08 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2024-02-02 | 2024-03-08 | N |
| Ensure that residents are free from significant medication errors. | Health | 2024-02-02 | 2024-03-08 | N |
| Provide or obtain dental services for each resident. | Health | 2024-02-02 | 2024-03-08 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2024-02-02 | 2024-03-08 | N |
| Administer the facility in a manner that enables it to use its resources effectively and efficiently. | Health | 2024-02-02 | 2024-03-08 | N |
| Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility. | Health | 2024-02-02 | 2024-03-08 | 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 | 2024-02-02 | 2024-03-08 | N |
| Designate a physician to serve as medical director responsible for implementation of resident care policies and coordination of medical care in the facility. | Health | 2024-02-02 | 2024-03-08 | N |
| Have a plan that describes the process for conducting QAPI and QAA activities. | Health | 2024-02-02 | 2024-03-08 | N |
| Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | Health | 2024-02-02 | 2024-03-08 | N |
| Provide and implement an infection prevention and control program. | Health | 2024-02-02 | 2024-03-08 | N |
| Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. | Health | 2024-02-02 | 2024-03-08 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2023-09-20 | 2023-10-13 | Y |
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2022-12-19 | 2023-02-08 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2022-12-19 | 2023-02-08 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-12-19 | 2023-02-08 | N |
| Implement a program that monitors antibiotic use. | Health | 2022-12-19 | 2023-02-08 | N |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2022-12-19 | 2023-01-20 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2022-12-19 | 2023-01-20 | N |
| Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | Health | 2022-12-19 | 2023-01-20 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2022-12-19 | 2023-01-20 | N |
| Respond appropriately to all alleged violations. | Health | 2022-12-19 | 2023-01-20 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-12-19 | 2023-01-20 | 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 | 2022-12-19 | 2023-01-20 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2022-12-19 | 2023-01-20 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-12-19 | 2023-01-20 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-12-19 | 2023-01-20 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2022-12-19 | 2023-01-20 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-12-19 | 2023-01-20 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2022-12-19 | 2023-01-20 | N |
| Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | Health | 2022-12-19 | 2023-01-20 | 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 | 2022-12-19 | 2023-01-20 | 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 | 2022-12-19 | 2023-01-20 | N |
| Provide or obtain dental services for each resident. | Health | 2022-12-19 | 2023-01-20 | N |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2022-12-19 | 2023-01-20 | N |
| Have a plan that describes the process for conducting QAPI and QAA activities. | Health | 2022-12-19 | 2023-01-20 | 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 | 2022-12-28 | 2023-01-13 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2022-12-28 | 2023-01-13 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-10-05 | 2022-09-30 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-10-05 | 2022-09-30 | Y |
| Establish procedures for tracking staff and patients during an emergency. | Fire Safety | 2021-08-16 | 2021-09-30 | N |
| Establish policies and procedures including evacuation. | Fire Safety | 2021-08-16 | 2021-09-30 | N |
| Establish policies and procedures for sheltering. | Fire Safety | 2021-08-16 | 2021-09-30 | N |
| Establish policies and procedures for volunteers. | Fire Safety | 2021-08-16 | 2021-09-30 | N |
| Implement emergency and standby power systems. | Fire Safety | 2021-08-16 | 2021-09-30 | N |
| 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 | 2021-08-16 | 2021-09-30 | N |
| Have an enclosure around a vertical opening shaft. | Fire Safety | 2021-08-16 | 2021-09-30 | 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 | 2021-08-16 | 2021-09-30 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2021-08-16 | 2021-09-30 | N |
| Install properly constructed and protected linen or trash chutes. | Fire Safety | 2021-08-16 | 2021-09-30 | N |
| Provide a written emergency evacuation plan. | Fire Safety | 2021-08-16 | 2021-09-30 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2021-08-16 | 2021-09-30 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2021-07-30 | 2021-09-22 | N |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2021-07-30 | 2021-09-07 | N |
| Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | Health | 2021-07-30 | 2021-09-07 | 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 | 2021-07-30 | 2021-09-07 | N |
| Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. | Health | 2021-07-30 | 2021-09-07 | N |
| Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | Health | 2021-07-30 | 2021-09-07 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2021-07-30 | 2021-09-07 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2021-07-30 | 2021-09-07 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2021-07-30 | 2021-09-07 | N |
| Provide activities to meet all resident's needs. | Health | 2021-07-30 | 2021-09-07 | N |
| Assist a resident in gaining access to vision and hearing services. | Health | 2021-07-30 | 2021-09-07 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-07-30 | 2021-09-07 | N |
| Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | Health | 2021-07-30 | 2021-09-07 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2021-07-30 | 2021-09-07 | 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 | 2021-07-30 | 2021-09-07 | N |
| Provide or obtain dental services for each resident. | Health | 2021-07-30 | 2021-09-07 | N |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2021-07-30 | 2021-09-07 | N |
| Provide and implement an infection prevention and control program. | Health | 2021-07-30 | 2021-09-07 | N |
| Perform COVID19 testing on residents and staff. | Health | 2021-07-30 | 2021-09-07 | N |
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