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Deficiency Records for Carmel Hills Wellness and Rehabilitation

A list of the most recent deficiencies for Carmel Hills Wellness and Rehabilitation. 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 Carmel Hills Wellness and Rehabilitation. 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?
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Health 2024-02-01 2024-02-08 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2024-02-01 2024-02-08 Y
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Health 2023-09-07 2023-09-08 Y
Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy. Health 2023-09-07 2023-09-08 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2023-09-07 2023-08-08 Y
Reasonably accommodate the needs and preferences of each resident. Health 2023-03-29 2023-05-13 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 2023-03-29 2023-05-13 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 2023-03-29 2023-05-13 N
Ensure services provided by the nursing facility meet professional standards of quality. Health 2023-03-29 2023-05-13 N
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Health 2023-03-29 2023-05-13 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 2023-03-29 2023-05-13 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 2023-03-29 2023-05-13 N
Provide safe and appropriate respiratory care for a resident when needed. Health 2023-03-29 2023-05-13 N
Provide safe, appropriate pain management for a resident who requires such services. Health 2023-03-29 2023-05-13 N
Provide safe, appropriate dialysis care/services for a resident who requires such services. Health 2023-03-29 2023-05-13 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 2023-03-29 2023-05-13 N
Provide routine and 24-hour emergency dental care for each resident. Health 2023-03-29 2023-05-13 N
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Health 2023-03-29 2023-05-13 N
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Health 2023-03-29 2023-05-13 N
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2023-03-29 2023-05-13 N
Have a policy regarding use and storage of foods brought to residents by family and other visitors. Health 2023-03-29 2023-05-13 N
Dispose of garbage and refuse properly. Health 2023-03-29 2023-05-13 N
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Health 2023-03-29 2023-05-13 N
Keep all essential equipment working safely. Health 2023-03-29 2023-05-13 N
Have policies on smoking. Health 2023-03-29 2023-05-13 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 2023-03-29 2023-05-13 N
Allow residents to self-administer drugs if determined clinically appropriate. Health 2023-03-29 2023-05-13 Y
Provide care and assistance to perform activities of daily living for any resident who is unable. Health 2023-03-29 2023-05-13 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2023-03-29 2023-05-13 Y
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. Health 2023-03-29 2023-05-13 Y
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Health 2023-03-29 2023-05-13 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 2023-03-29 2023-05-13 Y
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. Health 2023-03-29 2023-05-13 Y
Keep aisles, corridors, and exits free of obstruction in case of emergency. Fire Safety 2023-03-29 2023-05-13 N
Have exits that are accessible at all times. Fire Safety 2023-03-29 2023-05-13 N
Install emergency lighting that can last at least 1 1/2 hours. Fire Safety 2023-03-29 2023-05-13 N
Meet other general requirements that are deficient. Fire Safety 2023-03-29 2023-05-13 N
Provide properly protected cooking facilities. Fire Safety 2023-03-29 2023-05-13 N
Properly select, install, inspect, or maintain portable fire extinguishes. Fire Safety 2023-03-29 2023-05-13 N
Install corridor and hallway doors that block smoke. Fire Safety 2023-03-29 2023-05-13 N
Ensure smoke barriers are constructed to a 1 hour fire resistance rating. Fire Safety 2023-03-29 2023-05-13 N
Install smoke barrier doors that can resist smoke for at least 20 minutes. Fire Safety 2023-03-29 2023-05-13 N
Have an externally vented heating system. Fire Safety 2023-03-29 2023-05-13 N
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. Fire Safety 2023-03-29 2023-05-13 N
Have power receptacles that are properly grounded. Fire Safety 2023-03-29 2023-05-13 N
Have generator or other power source capable of supplying service within 10 seconds. Fire Safety 2023-03-29 2023-05-13 N
Meet requirements for the use of electrical equipment. Fire Safety 2023-03-29 2023-05-13 N
Have proper medical gas storage and administration areas. Fire Safety 2023-03-29 2023-05-13 N
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Health 2023-01-10 2023-02-22 Y
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2023-01-10 2023-02-22 Y
Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. Health 2023-01-10 2023-02-22 Y
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2022-10-25 2022-12-08 Y
Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. Health 2022-10-25 2022-12-08 Y
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 2022-10-25 2022-12-08 Y
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2022-09-01 2022-10-05 Y
Respond appropriately to all alleged violations. Health 2022-09-01 2022-10-05 Y
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2022-03-31 2022-03-31 Y
Protect each resident from the wrongful use of the resident's belongings or money. Health 2022-08-10 2021-08-08 Y
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 2020-03-09 2020-04-23 N
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. Health 2020-03-09 2020-04-23 N
Ensure each resident receives an accurate assessment. Health 2020-03-09 2020-04-23 N
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted Health 2020-03-09 2020-04-23 N
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2020-03-09 2020-04-23 N
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2020-03-09 2020-04-23 N
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2020-03-09 2020-04-23 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 2020-03-09 2020-04-23 N
Ensure each resident must receive and the facility must provide necessary behavioral health care and services. Health 2020-03-09 2020-04-23 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 2020-03-09 2020-04-23 N
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Health 2020-03-09 2020-04-23 N
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. Health 2020-03-09 2020-04-23 N
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2020-03-09 2020-04-23 N
Keep all essential equipment working safely. Health 2020-03-09 2020-04-23 N
Have simulated fire drills held at unexpected times. Fire Safety 2020-03-09 2020-04-23 N
Have generator or other power source capable of supplying service within 10 seconds. Fire Safety 2020-03-09 2020-04-23 N
Ensure proper usage of power strips and extension cords. Fire Safety 2020-03-09 2020-04-23 N
Have proper medical gas storage and administration areas. Fire Safety 2020-03-09 2020-04-23 N
Allow residents to easily view the nursing home's survey results and communicate with advocate agencies. Health 2019-01-16 2019-03-01 N
Not require residents to give up Medicare or Medicaid benefits, or pay privately as a condition of admission; and must tell residents what care they do not provide. Health 2019-01-16 2019-03-01 N
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Health 2019-01-16 2019-03-01 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 2019-01-16 2019-03-01 N
Ensure services provided by the nursing facility meet professional standards of quality. Health 2019-01-16 2019-03-01 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 2019-01-16 2019-03-01 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 2019-01-16 2019-03-01 N
Provide safe and appropriate respiratory care for a resident when needed. Health 2019-01-16 2019-03-01 N
Provide and implement an infection prevention and control program. Health 2019-01-16 2019-03-01 N
Implement a program that monitors antibiotic use. Health 2019-01-16 2019-03-01 N
To conduct inspection, testing and maintenance of fire doors by qualified individuals. Fire Safety 2019-01-16 2019-03-01 N

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