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Deficiency Records for Pleasant Valley Healthcare and Rehabilitation Cent
A list of the most recent deficiencies for Pleasant Valley Healthcare and Rehabilitation Cent. 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 Pleasant Valley Healthcare and Rehabilitation Cent. 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? |
|---|---|---|---|---|
| Reasonably accommodate the needs and preferences of each resident. | Health | 2024-03-14 | 2024-03-15 | N |
| Honor the resident's right to organize and participate in resident/family groups in the facility. | Health | 2024-03-14 | 2024-03-15 | N |
| Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Health | 2024-03-14 | 2024-03-15 | N |
| 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 | 2024-03-14 | 2024-03-15 | 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 | 2024-03-12 | 2024-03-13 | 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 | 2024-03-12 | 2024-03-13 | N |
| Have properly installed hallway dispensers for alcohol-based hand rub. | Fire Safety | 2024-03-12 | 2024-03-13 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2024-03-12 | 2024-03-13 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2024-03-12 | 2024-03-13 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2024-03-12 | 2024-03-13 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2024-03-12 | 2024-03-13 | N |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Health | 2023-11-24 | 2023-11-25 | Y |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2023-11-24 | 2023-11-25 | Y |
| Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. | Health | 2023-07-19 | 2023-07-20 | Y |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-05-05 | 2023-05-06 | Y |
| Ensure each resident receives an accurate assessment. | Health | 2023-02-06 | 2023-03-03 | Y |
| Provide and implement an infection prevention and control program. | Health | 2023-02-06 | 2023-03-03 | Y |
| Provide and implement an infection prevention and control program. | Health | 2023-01-19 | 2023-02-17 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-02-06 | 2023-02-07 | Y |
| 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 | 2022-12-19 | 2023-01-20 | Y |
| Ensure medication error rates are not 5 percent or greater. | Health | 2023-01-19 | 2023-01-20 | 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 | 2023-01-19 | 2023-01-20 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-01-19 | 2023-01-20 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2022-08-31 | 2022-09-26 | Y |
| Provide and implement an infection prevention and control program. | Health | 2022-08-31 | 2022-09-26 | Y |
| Provide and implement an infection prevention and control program. | Health | 2022-06-01 | 2022-06-16 | Y |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2021-10-21 | 2021-11-12 | 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 | 2021-10-21 | 2021-11-12 | 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 | 2021-10-21 | 2021-11-12 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2021-10-21 | 2021-11-12 | 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 | 2021-10-21 | 2021-11-12 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2021-10-21 | 2021-11-12 | 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 | 2021-10-20 | 2021-11-09 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2021-10-20 | 2021-11-09 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2021-10-20 | 2021-11-09 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2021-10-20 | 2021-11-09 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2021-10-20 | 2021-11-09 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2021-10-20 | 2021-11-09 | N |
| Provide safe, appropriate dialysis care/services for a resident who requires such services. | Health | 2024-09-14 | Not Fixed | Y |
| Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Health | 2024-09-14 | Not Fixed | Y |
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