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Deficiency Records for Lancaster Health Services
A list of the most recent deficiencies for Lancaster Health Services. 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 Lancaster Health Services. 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? |
|---|---|---|---|---|
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2024-07-24 | 2024-08-23 | N |
| Provide and implement an infection prevention and control program. | Health | 2024-07-24 | 2024-08-23 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2024-07-24 | 2024-08-23 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2024-07-24 | 2024-08-23 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2024-07-24 | 2024-08-23 | N |
| Meet requirements for the installation and maintenance of electrical systems. | Fire Safety | 2024-07-24 | 2024-08-23 | N |
| Have power receptacles that are properly grounded. | Fire Safety | 2024-07-24 | 2024-08-23 | N |
| Meet requirements for the use of electrical equipment. | Fire Safety | 2024-07-24 | 2024-08-23 | N |
| Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data. | Health | 2024-07-24 | 2024-07-24 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2024-04-24 | 2024-05-03 | Y |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-04-06 | 2023-05-02 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-04-06 | 2023-05-02 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2023-04-06 | 2023-05-02 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2023-04-03 | 2023-04-17 | N |
| Ensure staff are vaccinated for COVID-19 | Health | 2023-04-06 | 2023-04-06 | N |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2022-08-17 | 2022-09-09 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2022-08-17 | 2022-09-09 | Y |
| Respond appropriately to all alleged violations. | Health | 2022-08-17 | 2022-09-09 | Y |
| Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. | Fire Safety | 2022-01-12 | 2022-08-31 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2022-01-12 | 2022-05-19 | N |
| Construct fire resistant interior walls. | Fire Safety | 2022-01-12 | 2022-02-07 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2022-01-12 | 2022-02-07 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2022-01-12 | 2022-02-07 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2022-01-12 | 2022-02-07 | N |
| Have proper fire barriers, ventilation and signs for the transfilling of oxygen. | Fire Safety | 2022-01-12 | 2022-02-07 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-01-13 | 2022-02-05 | 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 | 2022-01-13 | 2022-02-05 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2022-01-13 | 2022-02-05 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-01-13 | 2022-02-05 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-01-13 | 2022-02-05 | N |
| Ensure that residents are free from significant medication errors. | Health | 2022-01-13 | 2022-02-05 | Y |
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