Inspection visit
Inspection
Citations
9 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
- 0039GeneralS&S Dpotential for harm
Conduct testing and exercise requirements.
- 0321GeneralS&S Dpotential for harm
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- 0372GeneralS&S Epotential for harm
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
F712 - Frequency of physician visits
Have simulated fire drills held at unexpected times.
F914 - Be designed or equipped to assure full visual privacy for each
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
F560 - The right to refuse to transfer to another room in the facility, if the purpose
Protect a residents' right to refuse some types of non-requested transfers within the nursing home.
F609 - The facility must develop and implement written policies and procedures that:
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
F732 - Nurse Staffing Information
Post nurse staffing information every day.
- 0363GeneralS&S Epotential for harm
Install corridor and hallway doors that block smoke.
FAQ · About this visit
Common questions about this visit
What happened during the January 26, 2023 survey of HAVEN OF DOUGLAS?
This was a inspection survey of HAVEN OF DOUGLAS on January 26, 2023. The surveyor cited 9 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at HAVEN OF DOUGLAS on January 26, 2023?
Yes, 9 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Conduct testing and exercise requirements."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.