Inspection Results » The Estates at Bloomington LLC

Health Inspection on February 13, 2019 ^[1]

1. Isolated: Actual harm that is not immediate jeopardy

   • Plan the resident's discharge to meet the resident's goals and needs. (Corrected 2019-03-12)
   • Provide enough food/fluids to maintain a resident's health. (Corrected 2019-03-15)
   • Provide appropriate pressure ulcer care and prevent new ulcers from developing. (Corrected 2019-03-15)

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

   • Provide and implement an infection prevention and control program. (Corrected 2019-03-29)
   • Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. (Corrected 2019-03-29)
   • Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. (Corrected 2019-03-29)

3. Pattern: 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 2019-03-29)
   • Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations and emergencies. (Corrected 2019-03-29)
   • Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. (Corrected 2019-03-29)
   • Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. (Corrected 2019-03-29)
   • Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. (Corrected 2019-03-29)
   • Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. (Corrected 2019-03-29)
   • 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. (Corrected 2019-03-29)
   • Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. (Corrected 2019-03-29)
   • 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. (Corrected 2019-03-29)
   • Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents. (Corrected 2019-03-29)

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

   • Provide activities to meet all resident's needs. (Corrected 2019-03-29)
   • Respond appropriately to all alleged violations. (Corrected 2019-03-29)
   • Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. (Corrected 2019-03-29)
   • Ensure each resident receives an accurate assessment. (Corrected 2019-03-29)
   • Ensure each resident must receive and the facility must provide necessary behavioral health care and services. (Corrected 2019-03-29)
   • Provide appropriate treatment and care according to orders, residentÂ’s preferences and goals. (Corrected 2019-03-29)
   • Reasonably accommodate the needs and preferences of each resident. (Corrected 2019-03-29)
   • Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. (Corrected 2019-03-29)
   • Observe each nurse aide's job performance and give regular training. (Corrected 2019-03-29)
   • Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. (Corrected 2019-03-29)
   • Keep all essential equipment working safely. (Corrected 2019-03-29)
   • Provide safe, appropriate pain management for a resident who requires such services. (Corrected 2019-03-29)
   • Provide safe, appropriate dialysis care/services for a resident who requires such services. (Corrected 2019-03-29)
   • Provide medically-related social services to help each resident achieve the highest possible quality of life. (Corrected 2019-03-29)
   • Provide safe and appropriate respiratory care for a resident when needed. (Corrected 2019-03-29)
   • Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. (Corrected 2019-03-29)
   • Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. (Corrected 2019-03-29)
   • Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. (Corrected 2019-03-29)
   • Provide care and assistance to perform activities of daily living for any resident who is unable. (Corrected 2019-03-29)
   • Ensure that residents are free from significant medication errors. (Corrected 2019-03-29)
   • Ensure medication error rates are not 5 percent or greater. (Corrected 2019-03-29)
   • Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. (Corrected 2019-03-29)
   • Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. (Corrected 2019-03-29)

5. Widespread: No actual harm with potential for minimal harm

   • Post nurse staffing information every day. (Corrected 2019-03-29)