Inspection Results » Luther Oaks

Health Inspection on June 20, 2018 ^[1]

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

   • Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. (Corrected 2018-07-08)
   • Implement a program that monitors antibiotic use. (Corrected 2018-07-26)
   • Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. (Corrected 2018-07-09)

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

   • Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install (Corrected 2018-07-06)
   • Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame. (Corrected 2018-07-06)

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

   • 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. (Corrected 2018-07-06)
   • Ensure each resident receives an accurate assessment. (Corrected 2018-07-06)
   • 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 2018-07-08)
   • Provide and implement an infection prevention and control program. (Corrected 2018-07-06)
   • Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. (Corrected 2018-07-06)
   • Provide enough food/fluids to maintain a resident's health. (Corrected 2018-07-06)
   • Provide appropriate pressure ulcer care and prevent new ulcers from developing. (Corrected 2018-07-06)
   • Ensure medication error rates are not 5 percent or greater. (Corrected 2018-07-06)
   • Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. (Corrected 2018-07-06)