Inspection Results » Four Seasons Healthcare & Wellness Center, Lp

Health Inspection on February 26, 2019 ^[1]

1. Isolated: Actual harm that is not immediate jeopardy

   • 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 ne (Corrected 2019-04-30)

2. Pattern: No actual harm with potential for more than minimal harm that is not immediate jeopardy

   • Ensure services provided by the nursing facility meet professional standards of quality. (Corrected 2019-04-13)
   • Ensure each resident must receive and the facility must provide necessary behavioral health care and services. (Corrected 2019-04-13)
   • Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. (Corrected 2019-04-13)
   • Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. (Corrected 2019-04-13)

3. Isolated: No actual harm with potential for more than minimal harm that is not immediate jeopardy

   • Ensure that residents are fully informed and understand their health status, care and treatments. (Corrected 2019-04-13)
   • Provide and implement an infection prevention and control program. (Corrected 2019-04-13)
   • Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. (Corrected 2019-04-30)
   • Ensure each residentÂ’s drug regimen must be free from unnecessary drugs. (Corrected 2019-04-30)
   • Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. (Corrected 2019-04-13)
   • Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. (Corrected 2019-04-13)
   • Provide safe and appropriate respiratory care for a resident when needed. (Corrected 2019-04-13)
   • Ensure that residents are free from significant medication errors. (Corrected 2019-04-13)

4. Pattern: No actual harm with potential for minimal harm

   • Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. (Corrected N/A)