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Deficiency Records for Bella Terrace Rehabilitation and Nursing Center

A list of the most recent deficiencies for Bella Terrace 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 Bella Terrace 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?
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Health 2024-08-20 2024-08-20 Y
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2024-07-01 2024-07-03 Y
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Health 2024-07-01 2024-07-03 Y
Provide care and assistance to perform activities of daily living for any resident who is unable. Health 2024-04-08 2024-04-18 Y
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Health 2023-08-30 2023-12-28 N
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 2023-08-30 2023-12-28 N
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. Health 2023-08-30 2023-12-28 N
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2023-08-30 2023-12-28 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 2023-08-30 2023-12-28 N
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2023-08-30 2023-12-28 N
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2023-08-30 2023-12-28 N
Provide appropriate foot care. Health 2023-08-30 2023-12-28 N
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2023-08-30 2023-12-28 N
Provide safe, appropriate pain management for a resident who requires such services. Health 2023-08-30 2023-12-28 N
Provide safe, appropriate dialysis care/services for a resident who requires such services. Health 2023-08-30 2023-12-28 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 2023-08-30 2023-12-28 N
Ensure each resident?s drug regimen must be free from unnecessary drugs. Health 2023-08-30 2023-12-28 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 2023-08-30 2023-12-28 N
Ensure that residents are free from significant medication errors. Health 2023-08-30 2023-12-28 N
Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. Health 2023-08-30 2023-12-28 N
Provide timely, approved x-ray services, or have an agreement with an approved provider to obtain them. Health 2023-09-12 2023-12-28 Y
Have exits that are accessible at all times. Fire Safety 2023-08-21 2023-12-28 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 2023-08-21 2023-12-28 N
Have approved installation, maintenance and testing program for fire alarm systems. Fire Safety 2023-08-21 2023-12-28 N
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. Fire Safety 2023-08-21 2023-12-28 N
Install properly constructed and protected linen or trash chutes. Fire Safety 2023-08-21 2023-12-28 N
Have simulated fire drills held at unexpected times. Fire Safety 2023-08-21 2023-12-28 N
Have power receptacles that are properly grounded. Fire Safety 2023-08-21 2023-12-28 N
Have generator or other power source capable of supplying service within 10 seconds. Fire Safety 2023-08-21 2023-12-28 N
Have proper medical gas storage and administration areas. Fire Safety 2023-08-21 2023-12-28 N
Use approved construction type or materials. Fire Safety 2023-08-21 2023-09-26 N
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2023-06-28 2023-07-18 Y
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Health 2023-06-28 2023-07-18 Y
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Health 2023-05-23 2023-07-18 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2023-05-15 2023-07-18 Y
Ensure that residents are free from significant medication errors. Health 2023-06-28 2023-06-28 Y
Reasonably accommodate the needs and preferences of each resident. Health 2023-03-23 2023-03-29 Y
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 2023-03-23 2023-03-29 Y
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Health 2023-03-23 2023-03-29 Y
Develop and implement policies and procedures to prevent abuse, neglect, and theft. Health 2022-11-30 2022-12-07 Y
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Health 2022-11-30 2022-12-07 Y
Respond appropriately to all alleged violations. Health 2022-11-30 2022-12-07 Y
Provide and implement an infection prevention and control program. Health 2022-08-12 2022-09-02 Y
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2022-08-05 2022-09-02 Y
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2022-08-05 2022-09-02 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 2022-06-29 2022-07-08 Y
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2022-06-15 2022-07-08 Y
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Health 2022-06-15 2022-07-08 Y
Provide enough food/fluids to maintain a resident's health. Health 2022-06-15 2022-07-08 Y
Allow resident to participate in the development and implementation of his or her person-centered plan of care. Health 2022-05-20 2022-07-08 Y
Ensure medication error rates are not 5 percent or greater. Health 2022-05-20 2022-07-08 Y
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Health 2022-05-20 2022-07-08 Y
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2022-05-04 2022-07-08 Y
Ensure medication error rates are not 5 percent or greater. Health 2022-05-04 2022-07-08 Y
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2022-04-07 2022-07-08 Y
Ensure each resident must receive and the facility must provide necessary behavioral health care and services. Health 2022-04-07 2022-07-08 Y
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Health 2022-04-07 2022-07-08 Y
Ensure that residents are free from significant medication errors. Health 2022-04-07 2022-07-08 Y
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 2022-04-07 2022-07-08 Y
Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. Health 2022-03-16 2022-07-08 Y
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2022-03-16 2022-07-08 Y
Post nurse staffing information every day. Health 2022-03-16 2022-07-08 Y
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Health 2022-03-16 2022-07-08 Y
Dispose of garbage and refuse properly. Health 2022-03-16 2022-07-08 Y
Provide and implement an infection prevention and control program. Health 2022-03-16 2022-07-08 Y
Develop and implement policies and procedures for flu and pneumonia vaccinations. Health 2022-03-16 2022-07-08 Y
Report COVID19 data to residents and families. Health 2022-03-16 2022-07-08 Y
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Health 2022-03-16 2022-07-08 Y
Keep residents' personal and medical records private and confidential. Health 2022-02-22 2022-07-08 Y
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 2022-02-22 2022-07-08 Y
Provide appropriate pressure ulcer care and prevent new ulcers from developing. Health 2022-02-22 2022-07-08 Y
Provide and implement an infection prevention and control program. Health 2022-02-22 2022-07-08 Y
Ensure staff are vaccinated for COVID-19 Health 2022-02-22 2022-07-08 Y
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2021-11-08 2021-11-22 Y
Ensure that residents are free from significant medication errors. Health 2021-11-08 2021-11-22 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 2021-11-08 2021-11-22 Y
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Health 2019-12-05 2019-12-31 N
Keep residents' personal and medical records private and confidential. Health 2019-12-05 2019-12-31 N
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Health 2019-12-05 2019-12-31 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 2019-12-05 2019-12-31 N
Provide appropriate treatment and care according to orders, resident?s preferences and goals. Health 2019-12-05 2019-12-31 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 2019-12-05 2019-12-31 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 2019-12-05 2019-12-31 N
Have approved installation, maintenance and testing program for fire alarm systems. Fire Safety 2019-12-02 2019-12-31 N
Properly select, install, inspect, or maintain portable fire extinguishes. Fire Safety 2019-12-02 2019-12-31 N
Ensure smoke barriers are constructed to a 1 hour fire resistance rating. Fire Safety 2019-12-02 2019-12-31 N
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. Fire Safety 2019-12-02 2019-12-31 N
Have proper medical gas storage and administration areas. Fire Safety 2019-12-02 2019-12-31 N
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Health 2019-07-11 2019-07-31 N
Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. Health 2019-07-11 2019-07-31 N
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Health 2019-07-11 2019-07-31 N
Ensure that residents are free from significant medication errors. Health 2019-07-11 2019-07-31 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 2019-07-11 2019-07-31 N
To conduct inspection, testing and maintenance of fire doors by qualified individuals. Fire Safety 2019-07-08 2019-07-31 N
Ensure operating rooms are properly protected and written records are maintained and available for inspection. Fire Safety 2019-07-08 2019-07-31 N
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. Fire Safety 2019-07-08 2019-07-31 N
Use approved construction type or materials. Fire Safety 2019-12-02 Not Fixed N
Use approved construction type or materials. Fire Safety 2019-07-08 Not Fixed N

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