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Deficiency Records for Downey Community Health Center
A list of the most recent deficiencies for Downey Community Health 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 Downey Community Health 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 and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2024-05-01 | 2024-06-01 | Y |
| Ensure that residents are fully informed and understand their health status, care and treatments. | Health | 2024-04-04 | 2024-05-01 | N |
| Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. | Health | 2024-04-04 | 2024-05-01 | N |
| Keep residents' personal and medical records private and confidential. | Health | 2024-04-04 | 2024-05-01 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2024-04-04 | 2024-05-01 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2024-04-04 | 2024-05-01 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2024-04-04 | 2024-05-01 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2024-04-04 | 2024-05-01 | 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 | 2024-04-04 | 2024-05-01 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2024-04-04 | 2024-05-01 | N |
| Ensure that residents are free from significant medication errors. | Health | 2024-04-04 | 2024-05-01 | N |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2024-04-04 | 2024-05-01 | N |
| Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. | Health | 2024-04-04 | 2024-05-01 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2024-04-04 | 2024-05-01 | N |
| Provide and implement an infection prevention and control program. | Health | 2024-04-04 | 2024-05-01 | N |
| Make sure that a working call system is available in each resident's bathroom and bathing area. | Health | 2024-04-04 | 2024-05-01 | 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 | 2024-04-09 | 2024-04-23 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2024-04-09 | 2024-04-23 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2024-04-09 | 2024-04-23 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2024-04-09 | 2024-04-23 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2024-02-05 | 2024-03-05 | Y |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2023-10-03 | 2023-11-02 | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2023-10-03 | 2023-11-02 | Y |
| Let each resident or the resident's legal representative access or purchase copies of all the resident's records. | Health | 2023-08-01 | 2023-08-21 | Y |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2023-02-23 | 2023-03-01 | Y |
| Provide emergency officials' contact information. | Fire Safety | 2022-03-02 | 2022-04-01 | N |
| Install an approved automatic sprinkler system. | Fire Safety | 2022-03-02 | 2022-04-01 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2022-03-02 | 2022-04-01 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2022-03-02 | 2022-04-01 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2022-03-02 | 2022-04-01 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2022-03-02 | 2022-04-01 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2022-03-02 | 2022-04-01 | N |
| Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Health | 2022-03-01 | 2022-03-30 | N |
| Reasonably accommodate the needs and preferences of each resident. | Health | 2022-03-01 | 2022-03-30 | 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 | 2022-03-01 | 2022-03-30 | N |
| Assess the resident when there is a significant change in condition | Health | 2022-03-01 | 2022-03-30 | N |
| Ensure each resident receives an accurate assessment. | Health | 2022-03-01 | 2022-03-30 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2022-03-01 | 2022-03-30 | 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 | 2022-03-01 | 2022-03-30 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2022-03-01 | 2022-03-30 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-03-01 | 2022-03-30 | 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 | 2022-03-01 | 2022-03-30 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2022-03-01 | 2022-03-30 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2022-03-01 | 2022-03-30 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-03-01 | 2022-03-30 | 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 | 2022-03-01 | 2022-03-30 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2022-03-01 | 2022-03-30 | N |
| Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit. | Health | 2022-03-01 | 2022-03-30 | N |
| Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. | Health | 2022-03-01 | 2022-03-30 | N |
| Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents. | Health | 2022-03-01 | 2022-03-30 | 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 | 2022-03-01 | 2022-03-30 | N |
| Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. | Health | 2022-03-01 | 2022-03-30 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-03-01 | 2022-03-30 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-03-01 | 2022-03-30 | N |
| Implement a program that monitors antibiotic use. | Health | 2022-03-01 | 2022-03-30 | N |
| Ensure staff are vaccinated for COVID-19 | Health | 2022-03-01 | 2022-03-30 | N |
| Keep all essential equipment working safely. | Health | 2022-03-01 | 2022-03-30 | N |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2022-03-01 | 2022-03-30 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-02-11 | 2022-03-03 | Y |
| Provide and implement an infection prevention and control program. | Health | 2021-10-12 | 2021-11-08 | 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 | 2020-01-10 | 2020-02-06 | N |
| PASARR screening for Mental disorders or Intellectual Disabilities | Health | 2020-01-10 | 2020-02-06 | N |
| Provide enough food/fluids to maintain a resident's health. | Health | 2020-01-10 | 2020-02-06 | N |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2020-01-10 | 2020-02-06 | N |
| Provide medically-related social services to help each resident achieve the highest possible quality of life. | Health | 2020-01-10 | 2020-02-06 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2020-01-10 | 2020-02-06 | 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 | 2020-01-10 | 2020-02-06 | N |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2020-01-10 | 2020-02-06 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2020-01-10 | 2020-02-06 | N |
| Provide and implement an infection prevention and control program. | Health | 2020-01-10 | 2020-02-06 | N |
| Implement a program that monitors antibiotic use. | Health | 2020-01-10 | 2020-02-06 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2020-01-07 | 2020-02-03 | N |
| Install a fire alarm system that can be heard throughout the facility. | Fire Safety | 2020-01-07 | 2020-02-03 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2020-01-07 | 2020-02-03 | N |
| Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. | Fire Safety | 2020-01-07 | 2020-02-03 | N |
| Have proper medical gas storage and administration areas. | Fire Safety | 2020-01-07 | 2020-02-03 | N |
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