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Deficiency Records for St Francis Rehabilitation and Nursing Center
A list of the most recent deficiencies for St Francis Rehabilitation and Nursing 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 St Francis Rehabilitation and Nursing 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? |
|---|---|---|---|---|
| Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. | Fire Safety | 2024-08-28 | 2024-09-30 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2024-08-28 | 2024-09-30 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2024-08-28 | 2024-09-30 | N |
| Have proper openings in smoke barrier doors. | Fire Safety | 2024-08-28 | 2024-09-30 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2024-08-28 | 2024-09-30 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2024-08-06 | 2024-08-24 | N |
| Give residents a notice of rights, rules, services and charges. | Health | 2024-08-06 | 2024-08-24 | 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 | 2024-08-06 | 2024-08-24 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2024-08-06 | 2024-08-24 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2024-08-06 | 2024-08-24 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2024-08-06 | 2024-08-24 | 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 | 2024-08-06 | 2024-08-24 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2024-04-25 | 2024-04-10 | Y |
| Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | Health | 2023-09-12 | 2023-09-25 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-09-12 | 2023-09-25 | Y |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2023-09-12 | 2023-09-25 | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2023-09-12 | 2023-09-25 | Y |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2023-04-11 | 2023-05-11 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2023-04-11 | 2023-05-01 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-04-11 | 2023-05-01 | N |
| Assist a resident in gaining access to vision and hearing services. | Health | 2023-04-11 | 2023-05-01 | N |
| 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 | 2023-04-11 | 2023-05-01 | N |
| Ensure that residents are free from significant medication errors. | Health | 2023-04-11 | 2023-05-01 | N |
| Provide or obtain dental services for each resident. | Health | 2023-04-11 | 2023-05-01 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-04-11 | 2023-05-01 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-01-03 | 2023-01-31 | N |
| Keep residents' personal and medical records private and confidential. | Health | 2022-05-31 | 2022-07-08 | Y |
| Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | Health | 2022-05-31 | 2022-05-31 | Y |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2022-05-31 | 2022-05-31 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2021-11-12 | 2021-11-05 | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2021-11-12 | 2021-11-05 | 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 | 2021-06-22 | 2021-07-09 | 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 | 2021-06-22 | 2021-07-09 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2021-06-22 | 2021-07-09 | N |
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