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Deficiency Records for Accordius Health at Creekside Care

A list of the most recent deficiencies for Accordius Health at Creekside Care. 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 Accordius Health at Creekside Care. 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?
Have properly installed electrical wiring and gas equipment. Fire Safety 2023-09-12 2023-10-13 N
Have generator or other power source capable of supplying service within 10 seconds. Fire Safety 2023-09-12 2023-10-13 N
Develop and implement policies and procedures for flu and pneumonia vaccinations. Health 2023-08-10 2023-09-28 N
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Health 2023-08-10 2023-09-07 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 2023-08-10 2023-09-07 N
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Health 2023-08-10 2023-09-07 N
Administer the facility in a manner that enables it to use its resources effectively and efficiently. Health 2022-02-04 2022-04-11 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 2022-02-04 2022-04-11 Y
Ensure that residents are free from significant medication errors. Health 2022-02-04 2022-04-11 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 2022-04-08 2022-04-11 Y
Ensure that residents are free from significant medication errors. Health 2022-04-08 2022-04-11 Y
Administer the facility in a manner that enables it to use its resources effectively and efficiently. Health 2022-04-08 2022-04-11 Y
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Health 2022-02-04 2022-04-08 N
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Health 2022-02-04 2022-04-08 N
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted Health 2022-02-04 2022-04-08 N
Provide enough food/fluids to maintain a resident's health. Health 2022-02-04 2022-04-08 N
Provide safe and appropriate respiratory care for a resident when needed. Health 2022-02-04 2022-04-08 N
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Health 2022-02-04 2022-04-08 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 2022-02-04 2022-04-08 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 2022-02-04 2022-04-08 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 2022-02-04 2022-04-08 N
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2022-02-04 2022-04-08 N
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Health 2022-02-04 2022-04-08 N
Keep all essential equipment working safely. Health 2022-02-04 2022-04-08 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 2022-02-04 2022-04-08 Y
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2022-02-04 2022-04-08 Y
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2022-02-04 2022-04-08 Y
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2022-02-04 2022-04-08 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2022-02-04 2022-04-08 Y
Provide and implement an infection prevention and control program. Health 2022-02-04 2022-04-08 Y
Post nurse staffing information every day. Health 2022-02-04 2022-03-08 Y
Properly provide smoke detection systems in areas open to corridors. Fire Safety 2019-09-18 2019-10-18 N
Ensure smoke barriers are constructed to a 1 hour fire resistance rating. Fire Safety 2019-09-18 2019-10-18 N
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted Health 2019-08-22 2019-09-09 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 2019-08-22 2019-09-09 N
Dispose of garbage and refuse properly. Health 2019-08-22 2019-09-09 N
Provide and implement an infection prevention and control program. Health 2019-08-22 2019-09-09 N

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