Inspection Results » St George Rehabilitation

Health Inspection on March 8, 2018 ^[1]

1. Isolated: Actual harm that is not immediate jeopardy

   • Provide appropriate treatment and care according to orders, residentÂ’s preferences and goals. (Corrected 2018-05-03)
   • Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. (Corrected 2018-05-03)

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

   • Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. (Corrected 2018-05-03)
   • Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. (Corrected 2018-05-03)
   • Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. (Corrected 2018-05-03)
   • Ensure that the resident and his/her doctor meet face-to-face at all required visits. (Corrected 2018-05-03)
   • Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. (Corrected 2018-05-03)
   • Ensure that residents are free from significant medication errors. (Corrected 2018-05-03)
   • Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. (Corrected 2018-05-03)
   • Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. (Corrected 2018-05-03)
   • Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. (Corrected 2018-05-03)
   • Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. (Corrected 2018-05-03)
   • 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 2018-05-03)
   • Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit. (Corrected 2018-05-03)
   • Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted (Corrected 2018-05-03)
   • Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. (Corrected 2018-05-03)
   • Ensure each residentÂ’s drug regimen must be free from unnecessary drugs. (Corrected 2018-05-03)
   • Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. (Corrected 2018-05-03)

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

   • Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. (Corrected 2018-05-03)
   • Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. (Corrected 2018-05-03)
   • Honor each resident's preferences, choices, values and beliefs. (Corrected 2018-05-03)
   • Allow residents to self-administer drugs if determined clinically appropriate. (Corrected 2018-05-03)
   • Obtain a doctor's order to admit a resident and ensure the resident is under a doctor's care. (Corrected 2018-05-03)
   • Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. (Corrected 2018-05-03)
   • Provide care and assistance to perform activities of daily living for any resident who is unable. (Corrected 2018-05-03)
   • Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. (Corrected 2018-05-03)
   • Ensure each resident receives an accurate assessment. (Corrected 2018-05-03)
   • Ensure each resident must receive and the facility must provide necessary behavioral health care and services. (Corrected 2018-05-03)
   • Ensure medication error rates are not 5 percent or greater. (Corrected 2018-05-03)
   • Provide medically-related social services to help each resident achieve the highest possible quality of life. (Corrected 2018-05-03)
   • 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 2018-05-03)