Inspection Results » Hillside Manor Healthcare and Rehab Center

Health Inspection on November 13, 2018 ^[1]

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

   • Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. (Corrected 2019-01-11)
   • Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. (Corrected 2019-01-11)
   • Honor the resident's right to manage his or her financial affairs. (Corrected 2019-01-11)

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

   • 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 2019-01-11)
   • Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. (Corrected 2019-01-11)
   • Respond appropriately to all alleged violations. (Corrected 2019-01-11)
   • PASARR screening for Mental disorders or Intellectual Disabilities (Corrected 2019-01-11)
   • Provide and implement an infection prevention and control program. (Corrected 2019-01-11)
   • Have a policy regarding use and storage of foods brought to residents by family and other visitors. (Corrected 2019-01-11)
   • Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. (Corrected 2019-01-11)
   • Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. (Corrected 2019-01-11)
   • Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. (Corrected 2019-01-11)
   • 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 2019-01-11)
   • 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 2019-01-11)
   • Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. (Corrected 2019-01-11)
   • Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. (Corrected 2019-01-11)

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

   • Provide safe, appropriate dialysis care/services for a resident who requires such services. (Corrected 2019-01-11)
   • Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted (Corrected 2019-01-11)
   • 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 2019-01-11)
   • 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 2019-01-11)
   • Provide care and assistance to perform activities of daily living for any resident who is unable. (Corrected 2019-01-11)
   • Ensure medication error rates are not 5 percent or greater. (Corrected 2019-01-11)
   • Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. (Corrected 2019-01-11)
   • Ensure each resident receives an accurate assessment. (Corrected 2019-01-11)
   • 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 2019-01-11)
   • Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. (Corrected 2019-01-11)
   • Ensure each residentÂ’s drug regimen must be free from unnecessary drugs. (Corrected 2019-01-11)
   • 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 2019-01-11)
   • Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. (Corrected 2019-01-11)
   • 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 2019-02-01)
   • Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. (Corrected 2019-01-11)
   • Provide activities to meet all resident's needs. (Corrected 2019-01-11)
   • Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. (Corrected 2019-01-11)
   • Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. (Corrected 2019-01-11)
   • Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. (Corrected 2019-01-11)