Autumn Care of Norfolk

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.

F0688 · Quality of Life and Care Deficiencies · Deficient, Provider has plan of correction (Sep 8, 2026) · From a complaint

Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

F0921 · Environmental Deficiencies · Deficient, Provider has plan of correction (Sep 8, 2026) · From a complaint

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

F0689 · Quality of Life and Care Deficiencies · Deficient, Provider has plan of correction (Sep 8, 2026) · From a complaint

Provide and implement an infection prevention and control program.

F0880 · Infection Control Deficiencies · Deficient, Provider has plan of correction (Sep 8, 2026) · From a complaint

Ensure medication error rates are not 5 percent or greater.

F0759 · Pharmacy Service Deficiencies · Deficient, Provider has date of correction (Feb 13, 2023)

Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

F0756 · Pharmacy Service Deficiencies · Deficient, Provider has date of correction (Feb 13, 2023)

Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.

F0636 · Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction (Feb 13, 2023)

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

F0580 · Resident Rights Deficiencies · Deficient, Provider has date of correction (Feb 13, 2023)

Ensure that residents are free from significant medication errors.

F0760 · Pharmacy Service Deficiencies · Deficient, Provider has date of correction (Feb 13, 2023)

Provide or get specialized rehabilitative services as required for a resident.

F0825 · Quality of Life and Care Deficiencies · Deficient, Provider has date of correction (Feb 13, 2023)

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

F0755 · Pharmacy Service Deficiencies · Deficient, Provider has date of correction (Feb 13, 2023)

Provide appropriate foot care.

F0687 · Quality of Life and Care Deficiencies · Deficient, Provider has date of correction (Feb 13, 2023)

Report COVID19 data to residents and families.

F0885 · Infection Control Deficiencies · Deficient, Provider has date of correction (Feb 13, 2023)

Provide care and assistance to perform activities of daily living for any resident who is unable.

F0677 · Quality of Life and Care Deficiencies · Deficient, Provider has date of correction (Feb 13, 2023)

Provide safe, appropriate dialysis care/services for a resident who requires such services.

F0698 · Quality of Life and Care Deficiencies · Deficient, Provider has date of correction (Feb 13, 2023)

Ensure services provided by the nursing facility meet professional standards of quality.

F0658 · Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction (Oct 18, 2019)

Ensure each resident receives an accurate assessment.

F0641 · Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction (Oct 18, 2019)

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.

F0584 · Resident Rights Deficiencies · Deficient, Provider has date of correction (Oct 18, 2019)

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

F0657 · Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction (Oct 18, 2019)

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

F0686 · Quality of Life and Care Deficiencies · Deficient, Provider has date of correction (Oct 18, 2019)

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

F0656 · Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction (Oct 18, 2019)

Develop and implement policies and procedures for flu and pneumonia vaccinations.

F0883 · Infection Control Deficiencies · Deficient, Provider has date of correction (Oct 18, 2019)

Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.

F0622 · Resident Rights Deficiencies · Deficient, Provider has date of correction (Oct 18, 2019)

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

F0842 · Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction (Oct 18, 2019)

Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made.

F0559 · Resident Rights Deficiencies · Deficient, Provider has date of correction (Oct 18, 2019)

Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.

F0625 · Resident Rights Deficiencies · Deficient, Provider has date of correction (Oct 18, 2019)

Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

F0756 · Pharmacy Service Deficiencies · Deficient, Provider has date of correction (Oct 18, 2019)

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

F0689 · Quality of Life and Care Deficiencies · Past Non-Compliance (Apr 17, 2019)

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

F0690 · Quality of Life and Care Deficiencies · Deficient, Provider has date of correction (Oct 18, 2019)

Allow resident to participate in the development and implementation of his or her person-centered plan of care.

F0553 · Resident Rights Deficiencies · Deficient, Provider has date of correction (Oct 18, 2019)

Provide activities to meet all resident's needs.

F0679 · Quality of Life and Care Deficiencies · Deficient, Provider has date of correction (Oct 18, 2019)

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

F0655 · Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction (Oct 18, 2019)

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

F0842 · Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction (Mar 30, 2018)

Ensure a qualified health professional conducts resident assessments.

F0642 · Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction (Mar 30, 2018)

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

F0812 · Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction (Mar 30, 2018)

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

F0686 · Quality of Life and Care Deficiencies · Deficient, Provider has date of correction (Mar 30, 2018)

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

F0655 · Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction (Mar 30, 2018)

Provide and implement an infection prevention and control program.

F0880 · Infection Control Deficiencies · Deficient, Provider has date of correction (Mar 30, 2018)

Allow residents to self-administer drugs if determined clinically appropriate.

F0554 · Resident Rights Deficiencies · Deficient, Provider has date of correction (Mar 30, 2018)

Provide safe, appropriate pain management for a resident who requires such services.

F0697 · Quality of Life and Care Deficiencies · Deficient, Provider has date of correction (Mar 30, 2018)

Have the Quality Assessment and Assurance group have the required members and meet at least quarterly

F0868 · Administration Deficiencies · Deficient, Provider has date of correction (Mar 30, 2018)

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

F0657 · Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction (Mar 30, 2018)

Provide safe and appropriate respiratory care for a resident when needed.

F0695 · Quality of Life and Care Deficiencies · Deficient, Provider has date of correction (Mar 30, 2018)

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.

F0761 · Pharmacy Service Deficiencies · Deficient, Provider has date of correction (Mar 30, 2018)

Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.

F0582 · Resident Rights Deficiencies · Deficient, Provider has date of correction (Mar 30, 2018)

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.

F0584 · Resident Rights Deficiencies · Deficient, Provider has date of correction (Mar 30, 2018)

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

F0690 · Quality of Life and Care Deficiencies · Deficient, Provider has date of correction (Mar 30, 2018)

Have generator or other power source capable of supplying service within 10 seconds.

K0918 · Gas, Vacuum, and Electrical Systems Deficiencies · Deficient, Provider has date of correction (Nov 14, 2019)

Inspect, test, and maintain automatic sprinkler systems.

K0353 · Smoke Deficiencies · Deficient, Provider has date of correction (Nov 14, 2019)

Establish staff and initial training requirements.

E0037 · Emergency Preparedness Deficiencies · Deficient, Provider has date of correction (Oct 18, 2019)

Establish emergency prep training and testing.

E0036 · Emergency Preparedness Deficiencies · Deficient, Provider has date of correction (Oct 18, 2019)

Ensure smoke barriers are constructed to a 1 hour fire resistance rating.

K0372 · Smoke Deficiencies · Deficient, Provider has date of correction (May 21, 2018)

Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.

K0223 · Egress Deficiencies · Deficient, Provider has date of correction (May 21, 2018)

Address subsistence needs for staff and patients.

E0015 · Emergency Preparedness Deficiencies · Deficient, Provider has date of correction (Mar 30, 2018)

Install corridor and hallway doors that block smoke.

K0363 · Smoke Deficiencies · Waiver has been granted (Jun 1, 2018)

Inspect, test, and maintain automatic sprinkler systems.

K0353 · Smoke Deficiencies · Deficient, Provider has date of correction (May 21, 2018)

Meet requirements for the installation and maintenance of electrical systems.

K0911 · Gas, Vacuum, and Electrical Systems Deficiencies · Deficient, Provider has date of correction (Jun 1, 2018)

Establish staff and initial training requirements.

E0037 · Emergency Preparedness Deficiencies · Deficient, Provider has date of correction (Mar 30, 2018)

Have approved installation, maintenance and testing program for fire alarm systems.

K0345 · Smoke Deficiencies · Deficient, Provider has date of correction (Jun 1, 2018)

Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke.

K0362 · Smoke Deficiencies · Deficient, Provider has date of correction (Jun 1, 2018)

Establish policies and procedures for sheltering.

E0022 · Emergency Preparedness Deficiencies · Deficient, Provider has date of correction (Mar 30, 2018)

Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.

K0222 · Egress Deficiencies · Waiver has been granted (Jun 1, 2018)

Establish policies and procedures for volunteers.

E0024 · Emergency Preparedness Deficiencies · Deficient, Provider has date of correction (Mar 30, 2018)

Install emergency lighting that can last at least 1 1/2 hours.

K0291 · Egress Deficiencies · Deficient, Provider has date of correction (Jun 1, 2018)