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Deficiency Records for Highland Square Nursing and Rehabilitation

A list of the most recent deficiencies for Highland Square Nursing 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 Highland Square Nursing 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?
Provide safe, appropriate pain management for a resident who requires such services. Health 2024-07-25 2024-08-19 Y
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2024-07-25 2024-08-19 Y
Have policies on smoking. Health 2024-07-25 2024-08-19 Y
Provide safe, appropriate pain management for a resident who requires such services. Health 2024-06-27 2024-08-19 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2024-05-24 2024-05-24 Y
Ensure residents have reasonable access to and privacy in their use of communication methods. Health 2024-02-27 2024-03-18 Y
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2024-02-27 2024-03-18 Y
Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. Health 2024-02-27 2024-03-18 Y
Honor the resident's right to choose his or her attending physician. Health 2024-02-21 2024-03-18 Y
Honor the resident's right to manage his or her financial affairs. Health 2024-02-21 2024-03-18 Y
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Health 2024-02-21 2024-03-18 Y
Respond appropriately to all alleged violations. Health 2024-02-21 2024-03-18 Y
Ensure services provided by the nursing facility meet professional standards of quality. Health 2024-02-21 2024-03-18 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2024-02-21 2024-03-18 Y
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Health 2024-01-18 2024-03-18 Y
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Health 2024-01-18 2024-03-18 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2024-01-18 2024-01-09 Y
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2023-12-18 2023-12-28 Y
Honor the resident's right to manage his or her financial affairs. Health 2023-09-01 2023-09-19 Y
Limit the charges against residents' personal funds for items or services for which payment is made under Medicare or Medicaid. Health 2023-09-01 2023-09-19 Y
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Health 2023-09-01 2023-09-19 Y
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Health 2023-09-01 2023-09-19 Y
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2023-07-19 2023-09-19 Y
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Health 2023-07-19 2023-09-19 Y
Protect each resident from the wrongful use of the resident's belongings or money. Health 2023-10-24 2023-09-13 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2023-03-21 2023-03-27 Y
Provide safe and appropriate respiratory care for a resident when needed. Health 2023-02-27 2023-03-27 Y
Make sure that a working call system is available in each resident's bathroom and bathing area. Health 2023-02-27 2023-03-27 Y
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2023-02-01 2023-03-27 Y
Ensure medication error rates are not 5 percent or greater. Health 2023-02-01 2023-03-27 Y
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Health 2023-02-01 2023-03-27 Y
Honor the resident's right to receive visitors of his or her choosing, at the time of his or her choosing. Health 2022-12-20 2023-01-06 Y
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Health 2022-12-20 2023-01-06 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 2022-12-20 2023-01-06 Y
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2022-11-29 2023-01-06 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 2022-11-29 2023-01-06 Y
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Health 2022-10-31 2022-11-11 Y
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Health 2022-10-31 2022-11-11 Y
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Health 2022-09-06 2022-09-23 Y
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Health 2022-05-20 2022-06-16 N
Encode each resident?s assessment data and transmit these data to the State within 7 days of assessment. Health 2022-05-20 2022-06-16 N
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2022-05-20 2022-06-16 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 2022-05-20 2022-06-16 N
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2022-05-20 2022-06-16 N
Provide enough food/fluids to maintain a resident's health. Health 2022-05-20 2022-06-16 N
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2022-05-20 2022-06-16 N
Provide and implement an infection prevention and control program. Health 2022-05-20 2022-06-16 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 2022-05-17 2022-06-16 N
Inspect, test, and maintain automatic sprinkler systems. Fire Safety 2022-05-17 2022-06-16 N
Install corridor and hallway doors that block smoke. Fire Safety 2022-05-17 2022-06-16 N
Ensure smoke barriers are constructed to a 1 hour fire resistance rating. Fire Safety 2022-05-17 2022-06-16 N
Meet other general requirements that are deficient. Fire Safety 2022-05-17 2022-06-16 N
Have properly installed electrical wiring and gas equipment. Fire Safety 2022-05-17 2022-06-16 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 2022-04-28 2022-05-05 Y
Let each resident or the resident's legal representative access or purchase copies of all the resident's records. Health 2021-12-28 2022-01-07 Y
Provide care and assistance to perform activities of daily living for any resident who is unable. Health 2021-12-28 2022-01-07 Y
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 2021-12-28 2022-01-07 Y
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2021-12-28 2022-01-07 Y
Keep residents' personal and medical records private and confidential. Health 2019-06-06 2019-07-09 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 2019-06-06 2019-07-09 N
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. Health 2019-06-06 2019-07-09 N
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2019-06-06 2019-07-09 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 2019-06-06 2019-07-09 N
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Health 2019-06-06 2019-07-09 N
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2019-06-06 2019-07-09 N
Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents. Health 2019-06-06 2019-07-09 N
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Health 2019-06-06 2019-07-09 N
Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. Health 2019-06-06 2019-07-09 N
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2019-06-06 2019-07-09 N
Provide and implement an infection prevention and control program. Health 2019-06-06 2019-07-09 N
Keep all essential equipment working safely. Health 2019-06-06 2019-07-09 N
Have an enclosure around a vertical opening shaft. Fire Safety 2019-06-03 2019-07-09 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 2019-06-03 2019-07-09 N
Inspect, test, and maintain automatic sprinkler systems. Fire Safety 2019-06-03 2019-07-09 N
Install corridor and hallway doors that block smoke. Fire Safety 2019-06-03 2019-07-09 N
Ensure smoke barriers are constructed to a 1 hour fire resistance rating. Fire Safety 2019-06-03 2019-07-09 N
Install smoke barrier doors that can resist smoke for at least 20 minutes. Fire Safety 2019-06-03 2019-07-09 N
Provide a written emergency evacuation plan. Fire Safety 2019-06-03 2019-07-09 N
Have restrictions on the use of portable space heaters. Fire Safety 2019-06-03 2019-07-09 N
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. Fire Safety 2019-06-03 2019-07-09 N
Ensure proper usage of power strips and extension cords. Fire Safety 2019-06-03 2019-07-09 N
Have proper medical gas storage and administration areas. Fire Safety 2019-06-03 2019-07-09 N
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Health 2018-04-19 2018-07-02 N
Ensure each resident receives an accurate assessment. Health 2018-04-19 2018-07-02 N
PASARR screening for Mental disorders or Intellectual Disabilities Health 2018-04-19 2018-07-02 N
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2018-04-19 2018-07-02 N
Meet other general requirements. Fire Safety 2018-04-18 2018-07-02 N
Use approved construction type or materials. Fire Safety 2018-04-18 2018-07-02 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 2018-04-18 2018-07-02 N
Have approved installation, maintenance and testing program for fire alarm systems. Fire Safety 2018-04-18 2018-07-02 N
Install an approved automatic sprinkler system. Fire Safety 2018-04-18 2018-07-02 N
Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke. Fire Safety 2018-04-18 2018-07-02 N
Install corridor and hallway doors that block smoke. Fire Safety 2018-04-18 2018-07-02 N
To conduct inspection, testing and maintenance of fire doors by qualified individuals. Fire Safety 2018-04-18 2018-07-02 N
Ensure proper usage of power strips and extension cords. Fire Safety 2018-04-18 2018-07-02 N

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