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Deficiency Records for Spiritrust Lutheran The Village at Gettysburg
A list of the most recent deficiencies for Spiritrust Lutheran The Village at Gettysburg. 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 Spiritrust Lutheran The Village at Gettysburg. 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? |
|---|---|---|---|---|
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2024-05-28 | 2024-06-28 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2024-05-28 | 2024-06-28 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2024-05-28 | 2024-06-28 | N |
| Have power receptacles that are properly grounded. | Fire Safety | 2024-05-28 | 2024-06-28 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2024-05-28 | 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 | 2024-05-02 | 2024-06-18 | 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 | 2024-05-02 | 2024-06-18 | 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 | 2024-05-02 | 2024-06-18 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-07-20 | 2023-08-31 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-07-20 | 2023-08-31 | N |
| Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | Health | 2023-07-20 | 2023-08-31 | N |
| Develop, implement, and/or maintain an effective training program for all new and existing staff members. | Health | 2023-07-20 | 2023-08-31 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-07-20 | 2023-08-11 | N |
| 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 | 2023-07-20 | 2023-08-11 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2023-07-20 | 2023-08-11 | N |
| Use approved construction type or materials. | Fire Safety | 2023-07-05 | 2023-08-11 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2023-07-05 | 2023-08-11 | 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 | 2023-07-05 | 2023-08-11 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2023-07-05 | 2023-08-11 | N |
| Ensure each resident receives an accurate assessment. | Health | 2022-08-11 | 2022-09-16 | N |
| 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 | 2022-08-11 | 2022-09-16 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2022-08-11 | 2022-09-16 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-08-11 | 2022-09-16 | N |
| Use approved construction type or materials. | Fire Safety | 2022-08-18 | 2022-09-16 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2022-08-18 | 2022-09-16 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2022-08-18 | 2022-09-16 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2022-08-18 | 2022-09-16 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2022-08-18 | 2022-09-16 | N |
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