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Deficiency Records for Fort Atkinson Care Center
A list of the most recent deficiencies for Fort Atkinson Care 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 Fort Atkinson Care 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 appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2024-06-12 | 2024-10-21 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2024-04-25 | 2024-10-21 | Y |
| Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility. | Health | 2024-07-24 | 2024-08-15 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2024-06-12 | 2024-07-16 | Y |
| Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. | Health | 2024-06-12 | 2024-07-16 | Y |
| Plan the resident's discharge to meet the resident's goals and needs. | Health | 2024-06-12 | 2024-07-16 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2024-06-12 | 2024-07-16 | Y |
| Provide appropriate foot care. | Health | 2024-06-12 | 2024-07-16 | Y |
| Provide and implement an infection prevention and control program. | Health | 2024-06-12 | 2024-07-16 | Y |
| Provide and implement an infection prevention and control program. | Health | 2024-04-25 | 2024-07-16 | Y |
| Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. | Health | 2024-04-25 | 2024-05-23 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2024-04-25 | 2024-05-23 | N |
| Notify the resident or the resident?s representative in writing how long the nursing home will hold the resident?s bed in cases of transfer to a hospital or therapeutic leave. | Health | 2024-04-25 | 2024-05-23 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2024-04-25 | 2024-05-23 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2024-04-25 | 2024-05-23 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2024-04-25 | 2024-05-23 | 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 | 2024-04-25 | 2024-05-23 | N |
| Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. | Health | 2024-04-25 | 2024-05-23 | 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 | 2024-04-25 | 2024-05-23 | 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 | 2024-04-25 | 2024-05-23 | N |
| Respond appropriately to all alleged violations. | Health | 2024-04-25 | 2024-05-23 | Y |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2024-04-25 | 2024-05-23 | Y |
| Ensure each resident receives and the facility provides drinks consistent with resident needs and preferences and sufficient to maintain resident hydration. | Health | 2024-04-25 | 2024-05-23 | Y |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2024-04-25 | 2024-05-23 | Y |
| Conduct risk assessment and an All-Hazards approach. | Fire Safety | 2024-04-10 | 2024-05-23 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2024-04-10 | 2024-05-23 | 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 | 2024-04-10 | 2024-05-23 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2024-04-10 | 2024-05-23 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2024-04-10 | 2024-05-23 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2024-04-10 | 2024-05-23 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2024-04-10 | 2024-05-23 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2024-04-10 | 2024-05-23 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2024-04-10 | 2024-05-23 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2024-04-10 | 2024-05-23 | N |
| Meet requirements for the installation and maintenance of electrical systems. | Fire Safety | 2024-04-10 | 2024-05-23 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2024-04-10 | 2024-05-23 | N |
| Meet requirements for the use of electrical equipment. | Fire Safety | 2024-04-10 | 2024-05-23 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2024-04-10 | 2024-05-23 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2024-04-10 | 2024-05-23 | N |
| Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident?s advance directives. | Health | 2024-04-25 | 2024-04-25 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2024-03-07 | 2024-03-19 | Y |
| Provide safe, appropriate pain management for a resident who requires such services. | Health | 2024-03-07 | 2024-03-19 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2024-02-21 | 2024-03-12 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-12-12 | 2024-03-12 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-10-16 | 2024-03-12 | Y |
| Give residents a notice of rights, rules, services and charges. | Health | 2023-12-12 | 2024-01-12 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2023-12-12 | 2024-01-12 | Y |
| Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident?s advance directives. | Health | 2023-12-12 | 2024-01-12 | Y |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2023-12-12 | 2024-01-12 | Y |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-12-12 | 2024-01-12 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2023-10-16 | 2023-11-10 | Y |
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2023-10-16 | 2023-11-10 | Y |
| Keep residents' personal and medical records private and confidential. | Health | 2023-10-16 | 2023-11-10 | 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 | 2023-10-16 | 2023-11-10 | Y |
| Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. | Health | 2023-10-16 | 2023-11-10 | Y |
| Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | Health | 2023-10-16 | 2023-11-10 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-10-16 | 2023-11-10 | 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 | 2023-10-16 | 2023-11-10 | Y |
| Ensure medication error rates are not 5 percent or greater. | Health | 2023-10-16 | 2023-11-10 | Y |
| Ensure that residents are free from significant medication errors. | Health | 2023-10-16 | 2023-11-10 | Y |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2023-10-16 | 2023-11-10 | Y |
| Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. | Health | 2023-10-16 | 2023-11-10 | Y |
| Provide special eating equipment and utensils for residents who need them and appropriate assistance. | Health | 2023-10-16 | 2023-11-10 | Y |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-10-16 | 2023-11-10 | Y |
| Dispose of garbage and refuse properly. | Health | 2023-10-16 | 2023-11-10 | Y |
| Provide or get specialized rehabilitative services as required for a resident. | Health | 2023-10-16 | 2023-11-10 | Y |
| Provide and implement an infection prevention and control program. | Health | 2023-10-16 | 2023-11-10 | Y |
| Have a battery powered remote alarm panel in a location accessible by operating personnel. | Fire Safety | 2023-01-10 | 2023-05-08 | N |
| Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made. | Health | 2023-03-21 | 2023-04-15 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-03-21 | 2023-04-15 | Y |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-03-21 | 2023-04-15 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2023-02-15 | 2023-04-15 | Y |
| Respond appropriately to all alleged violations. | Health | 2023-02-15 | 2023-04-15 | Y |
| Ensure that residents are free from significant medication errors. | Health | 2023-02-15 | 2023-04-15 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2023-01-14 | 2023-04-15 | Y |
| Protect each resident from the wrongful use of the resident's belongings or money. | Health | 2023-01-14 | 2023-04-15 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-01-14 | 2023-04-15 | Y |
| Not hire anyone with a finding of abuse, neglect, exploitation, or theft. | Health | 2023-01-14 | 2023-04-15 | 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 | 2023-01-14 | 2023-04-15 | N |
| Dispose of garbage and refuse properly. | Health | 2023-01-14 | 2023-04-15 | N |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-01-14 | 2023-04-15 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-01-14 | 2023-04-15 | Y |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-01-14 | 2023-04-15 | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2023-01-14 | 2023-04-15 | Y |
| Provide and implement an infection prevention and control program. | Health | 2023-01-14 | 2023-04-15 | Y |
| 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 | 2023-01-10 | 2023-02-03 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2023-01-10 | 2023-01-24 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2023-01-10 | 2023-01-16 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-08-31 | 2022-09-15 | Y |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-06-01 | 2022-07-23 | Y |
| Allow resident to participate in the development and implementation of his or her person-centered plan of care. | Health | 2022-06-01 | 2022-07-06 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-06-01 | 2022-07-06 | Y |
| Ensure that residents are free from significant medication errors. | Health | 2022-06-01 | 2022-07-06 | Y |
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2021-09-15 | 2021-10-14 | N |
| Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. | Health | 2021-09-15 | 2021-10-14 | 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 | 2021-09-15 | 2021-10-14 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2021-09-15 | 2021-10-14 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-09-15 | 2021-10-14 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2021-09-15 | 2021-10-14 | 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 | 2021-09-15 | 2021-10-14 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2021-09-15 | 2021-10-14 | 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 | 2021-09-15 | 2021-10-14 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2021-09-15 | 2021-10-14 | 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 | 2021-09-15 | 2021-10-14 | N |
| Provide and implement an infection prevention and control program. | Health | 2021-09-15 | 2021-10-14 | 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 | 2021-09-13 | 2021-10-14 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2021-09-13 | 2021-10-14 | 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 | 2021-09-13 | 2021-10-14 | N |
| Construct fire resistant interior walls. | Fire Safety | 2021-09-13 | 2021-10-14 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2021-09-13 | 2021-10-14 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2021-09-13 | 2021-10-14 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2021-09-13 | 2021-10-14 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2021-09-13 | 2021-10-14 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2021-09-13 | 2021-10-14 | N |
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