Inspection Results » Freedom Square Rehabilitation & Nursing Services

Health Inspection on October 5, 2018 ^[1]

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

   • Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. (Corrected 2018-12-14)
   • Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. (Corrected 2018-11-05)
   • Provide and implement an infection prevention and control program. (Corrected 2018-12-14)
   • Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. (Corrected 2018-11-05)
   • Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. (Corrected 2018-11-05)

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

   • Notify the resident or the residentÂ’s representative in writing how long the nursing home will hold the residentÂ’s bed in cases of transfer to a hospital or therapeutic leave. (Corrected 2018-11-05)
   • Provide appropriate pressure ulcer care and prevent new ulcers from developing. (Corrected 2018-12-14)
   • Ensure medication error rates are not 5 percent or greater. (Corrected 2018-11-05)
   • Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. (Corrected 2018-11-05)
   • 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. (Corrected 2018-11-05)
   • Ensure services provided by the nursing facility meet professional standards of quality. (Corrected 2018-11-05)
   • Keep all essential equipment working safely. (Corrected 2018-11-05)
   • 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. (Corrected 2018-11-05)
   • Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. (Corrected 2018-11-05)
   • Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. (Corrected 2018-11-05)