Inspection Results » Diversicare of Siena Woods

Health Inspection on October 18, 2018 ^[1]

1. Isolated: Actual harm that is not immediate jeopardy

   • Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. (Corrected 2018-11-19)

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 2018-11-19)
   • 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 2018-11-19)

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

   • Provide activities to meet all resident's needs. (Corrected 2018-11-19)
   • Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. (Corrected 2018-11-19)
   • Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. (Corrected 2018-11-19)

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

   • Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. (Corrected 2018-11-19)
   • Provide timely, quality laboratory services/tests to meet the needs of residents. (Corrected 2018-11-19)
   • 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 2018-11-19)
   • Provide safe, appropriate pain management for a resident who requires such services. (Corrected 2018-11-19)
   • Provide appropriate pressure ulcer care and prevent new ulcers from developing. (Corrected 2018-11-19)
   • Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. (Corrected 2018-11-19)
   • Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. (Corrected 2018-11-19)
   • Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. (Corrected 2018-11-19)
   • Provide appropriate treatment and care according to orders, residentÂ’s preferences and goals. (Corrected 2018-11-19)