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Deficiency Records for Colonial Manor Ii
A list of the most recent deficiencies for Colonial Manor Ii. 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 Colonial Manor Ii. 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? |
---|---|---|---|---|
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2024-06-07 | 2024-09-19 | Y |
Encode each resident?s assessment data and transmit these data to the State within 7 days of assessment. | Health | 2024-06-01 | 2024-06-28 | 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 | 2024-06-01 | 2024-06-28 | 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 | 2024-06-01 | 2024-06-28 | N |
Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data. | Health | 2024-06-01 | 2024-06-28 | N |
Provide and implement an infection prevention and control program. | Health | 2024-06-01 | 2024-06-28 | N |
Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation. | Health | 2024-06-07 | 2024-06-18 | Y |
Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2024-06-12 | 2024-06-18 | N |
To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2024-06-12 | 2024-06-13 | 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 | 2023-04-17 | 2023-05-18 | N |
Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-04-17 | 2023-05-18 | 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 | 2023-04-17 | 2023-05-18 | 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 | 2023-04-27 | 2023-05-18 | N |
Properly provide smoke detection systems in areas open to corridors. | Fire Safety | 2022-04-20 | 2022-07-29 | N |
Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-04-20 | 2022-07-29 | N |
To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2022-04-20 | 2022-07-29 | N |
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. | Health | 2022-04-22 | 2022-06-22 | N |
Observe each nurse aide's job performance and give regular training. | Health | 2022-04-22 | 2022-06-22 | N |
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2022-04-20 | 2022-06-07 | N |
Have simulated fire drills held at unexpected times. | Fire Safety | 2022-04-20 | 2022-06-02 | N |
Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2022-04-20 | 2022-05-25 | 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 | 2022-04-20 | 2022-05-18 | N |
Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2022-04-20 | 2022-05-11 | N |
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