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Deficiency Records for Nazareth Health and Rehab Center
A list of the most recent deficiencies for Nazareth Health and Rehab 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 Nazareth Health and Rehab 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? |
|---|---|---|---|---|
| Develop Emergency Preparedness policies and procedures. | Fire Safety | 2023-11-29 | 2024-01-25 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2023-11-29 | 2024-01-25 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2023-11-29 | 2024-01-25 | 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 | 2023-11-29 | 2024-01-12 | N |
| Have elevators that firefighters can control in the event of a fire. | Fire Safety | 2023-11-29 | 2024-01-12 | N |
| Meet requirements for the installation and maintenance of electrical systems. | Fire Safety | 2023-11-29 | 2024-01-12 | N |
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2023-11-30 | 2023-12-27 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-11-30 | 2023-12-27 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2023-11-30 | 2023-12-27 | N |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2023-11-30 | 2023-12-27 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-11-30 | 2023-12-27 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-11-30 | 2023-12-27 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2023-11-30 | 2023-12-27 | N |
| Meet requirements for outpatient facilities located next to inpatient facilities separated by fire resistive construction. | Fire Safety | 2023-11-29 | 2023-12-27 | N |
| Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector. | Fire Safety | 2023-11-29 | 2023-12-27 | 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 | 2023-11-29 | 2023-12-27 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-11-29 | 2023-12-27 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2023-11-29 | 2023-12-27 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2023-11-29 | 2023-12-27 | N |
| Have power receptacles that are properly grounded. | Fire Safety | 2023-11-29 | 2023-12-27 | N |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2023-07-20 | 2023-08-04 | Y |
| Respond appropriately to all alleged violations. | Health | 2023-07-20 | 2023-08-04 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-07-20 | 2023-08-04 | Y |
| Provide and implement an infection prevention and control program. | Health | 2023-07-20 | 2023-08-04 | Y |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2023-07-20 | 2023-06-16 | Y |
| Respond appropriately to all alleged violations. | Health | 2023-03-07 | 2023-03-27 | Y |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2023-03-07 | 2023-03-27 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-09-13 | 2022-10-12 | N |
| Provide safe, appropriate pain management for a resident who requires such services. | Health | 2022-09-13 | 2022-10-12 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-09-13 | 2022-10-12 | N |
| Conduct testing and exercise requirements. | Fire Safety | 2022-09-08 | 2022-10-12 | N |
| Install emergency lighting that can last at least 1 1/2 hours. | Fire Safety | 2022-09-08 | 2022-10-12 | 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 | 2022-09-08 | 2022-10-12 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2022-09-08 | 2022-10-12 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2022-09-08 | 2022-10-12 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2022-09-08 | 2022-10-12 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2022-09-08 | 2022-10-12 | 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 | 2022-09-08 | 2022-09-29 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-09-08 | 2022-09-29 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2022-09-08 | 2022-09-29 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2022-02-16 | 2022-03-11 | Y |
| Install a fire alarm system that can be heard throughout the facility. | Fire Safety | 2021-07-01 | 2021-11-19 | N |
| Have a complete alarm system manually initiated and initiated by fire sprinkler system connection. | Fire Safety | 2021-07-01 | 2021-11-19 | N |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2021-07-01 | 2021-08-01 | N |
| Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | Health | 2021-07-01 | 2021-08-01 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2021-07-01 | 2021-08-01 | 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 | 2021-07-01 | 2021-08-01 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2021-07-01 | 2021-08-01 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2021-07-01 | 2021-08-01 | 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 | 2021-07-01 | 2021-08-01 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2021-07-01 | 2021-08-01 | N |
| Develop and maintain an Emergency Preparedness Program (EP). | Fire Safety | 2021-07-01 | 2021-08-01 | N |
| Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector. | Fire Safety | 2021-07-01 | 2021-08-01 | N |
| Construct fire resistant interior walls. | Fire Safety | 2021-07-01 | 2021-08-01 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2021-07-01 | 2021-08-01 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2021-07-01 | 2021-08-01 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2021-07-01 | 2021-08-01 | N |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Fire Safety | 2021-07-01 | 2021-08-01 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2021-07-01 | 2021-08-01 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2021-07-01 | 2021-07-02 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2021-07-01 | 2021-07-02 | N |
| Have an enclosure around a vertical opening shaft. | Fire Safety | 2023-11-29 | Not Fixed | N |
| Have an enclosure around a vertical opening shaft. | Fire Safety | 2022-09-08 | Not Fixed | N |
| Have an enclosure around a vertical opening shaft. | Fire Safety | 2021-07-01 | Not Fixed | N |
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