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Deficiency Records for Hillcrest Firethorn
A list of the most recent deficiencies for Hillcrest Firethorn. 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 Hillcrest Firethorn. 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? |
|---|---|---|---|---|
| Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. | Health | 2024-04-11 | 2024-05-21 | 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 | 2024-04-11 | 2024-05-21 | N |
| Provide and implement an infection prevention and control program. | Health | 2024-04-11 | 2024-05-21 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2024-04-11 | 2024-05-21 | Y |
| 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 | 2024-04-10 | 2024-05-21 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2024-04-10 | 2024-05-21 | N |
| Meet other general requirements that are deficient. | Fire Safety | 2024-04-10 | 2024-05-21 | N |
| Provide a written emergency evacuation plan. | Fire Safety | 2024-04-10 | 2024-05-21 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2024-04-10 | 2024-05-21 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2024-04-10 | 2024-05-21 | N |
| Meet requirements for the use of electrical equipment. | Fire Safety | 2024-04-10 | 2024-05-21 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2024-04-10 | 2024-05-21 | N |
| Ensure that testing and maintenance of electrical equipment is performed. | Fire Safety | 2024-04-10 | 2024-05-21 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2023-05-11 | 2023-07-12 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-05-16 | 2023-06-21 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-05-16 | 2023-06-21 | Y |
| Implement emergency and standby power systems. | Fire Safety | 2023-05-11 | 2023-06-21 | 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 | 2023-05-11 | 2023-06-21 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2023-05-11 | 2023-06-21 | N |
| Follow proper procedures when the fire alarm was out of service for more than 4 hours. | Fire Safety | 2023-05-11 | 2023-06-21 | N |
| Meet other general requirements that are deficient. | Fire Safety | 2023-05-11 | 2023-06-21 | N |
| Provide a written emergency evacuation plan. | Fire Safety | 2023-05-11 | 2023-06-21 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2023-05-11 | 2023-06-21 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-05-11 | 2023-06-21 | N |
| Meet requirements for the use of electrical equipment. | Fire Safety | 2023-05-11 | 2023-06-21 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2023-05-11 | 2023-06-21 | N |
| Assess the resident when there is a significant change in condition | Health | 2022-01-20 | 2022-03-02 | N |
| Ensure each resident receives an accurate assessment. | Health | 2022-01-20 | 2022-03-02 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-01-20 | 2022-03-02 | 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 | 2022-01-20 | 2022-03-02 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2022-01-20 | 2022-03-02 | 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 | 2022-01-20 | 2022-03-02 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2022-01-20 | 2022-03-02 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2022-01-20 | 2022-03-02 | Y |
| Provide and implement an infection prevention and control program. | Health | 2022-01-20 | 2022-03-02 | Y |
| Implement emergency and standby power systems. | Fire Safety | 2022-01-13 | 2022-03-02 | 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 | 2022-01-13 | 2022-03-02 | 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 | 2022-01-13 | 2022-03-02 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2022-01-13 | 2022-03-02 | N |
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