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Inspection visit

Inspection

SUMMIT, THECMS #26576936 citations on this visit
36 citations recorded

Citations

36 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.

  • 0576GeneralS&S Epotential for harm

    F576 - The resident has the right to have reasonable access to the use of a telephone,

    Ensure residents have reasonable access to and privacy in their use of communication methods.

  • 0584GeneralS&S Epotential for harm

    F584 - Safe Environment

    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.

  • 0585GeneralS&S Dpotential for harm

    F585 - Grievances

    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.

  • 0607GeneralS&S Epotential for harm

    F607 - The facility must develop and implement written policies and procedures that:

    Develop and implement policies and procedures to prevent abuse, neglect, and theft.

  • 0623GeneralS&S Dpotential for harm

    F623 - Transfer and discharge-

    Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.

  • 0625GeneralS&S Dpotential for harm

    F625 - Transfer and discharge-

    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.

  • 0636GeneralS&S Epotential for harm

    F636 - Resident Assessment

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

  • 0637GeneralS&S Dpotential for harm

    F637 - Within 14 days after the facility determines, or should have determined,

    Assess the resident when there is a significant change in condition

  • 0638GeneralS&S Epotential for harm

    F638 - Quarterly Review Assessment

    Assure that each resident’s assessment is updated at least once every 3 months.

  • 0640GeneralS&S Epotential for harm

    F640 - Automated data processing requirement-

    Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.

  • 0641GeneralS&S Epotential for harm

    F641 - Accuracy of Assessments

    Ensure each resident receives an accurate assessment.

  • 0656GeneralS&S Epotential for harm

    F656 - Comprehensive Care Plans

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

  • 0679GeneralS&S Dpotential for harm

    F679 - Activities

    Provide activities to meet all resident's needs.

  • 0684GeneralS&S Dpotential for harm

    F684 - Quality of care

    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

  • 0689GeneralS&S Epotential for harm

    F689 - Accidents

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

  • 0695GeneralS&S Dpotential for harm

    F695 - Respiratory care, including tracheostomy care and tracheal suctioning

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

  • 0698GeneralS&S Dpotential for harm

    F698 - Dialysis

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

  • 0803GeneralS&S Fpotential for harm

    F803 - Menus and nutritional adequacy

    Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

  • 0812GeneralS&S Fpotential for harm

    F812 - Food safety requirements

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

  • 0813GeneralS&S Dpotential for harm

    F813 - Food Safety Requirements

    Have a policy regarding use and storage of foods brought to residents by family and other visitors.

  • 0880GeneralS&S Fpotential for harm

    F880 - Infection Control

    Provide and implement an infection prevention and control program.

  • 0925GeneralS&S Epotential for harm

    F925 - Maintain an effective pest control program so that the facility is free of

    Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

  • 0814GeneralS&S Epotential for harm

    F814 - Food Safety Requirements

    Dispose of garbage and refuse properly.

  • 0015GeneralS&S Fpotential for harm

    Address subsistence needs for staff and patients.

  • 0020GeneralS&S Fpotential for harm

    Establish policies and procedures including evacuation.

  • 0291GeneralS&S Fpotential for harm

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

  • 0300GeneralS&S Dpotential for harm

    Meet other general requirements that are deficient.

  • 0321GeneralS&S Epotential for harm

    Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

  • 0324GeneralS&S Epotential for harm

    Provide properly protected cooking facilities.

  • 0345GeneralS&S Fpotential for harm

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

  • 0353GeneralS&S Fpotential for harm

    Inspect, test, and maintain automatic sprinkler systems.

  • 0354GeneralS&S Fpotential for harm

    Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.

  • 0500GeneralS&S Fpotential for harm

    Meet other general requirements that are deficient.

  • 0741GeneralS&S Epotential for harm

    F741 - The facility must have sufficient staff who provide direct services to

    Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.

  • 0918GeneralS&S Fpotential for harm

    F918 - Bathroom Facilities

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

  • 0919GeneralS&S Epotential for harm

    F919 - Resident Call System

    Meet requirements for the use of electrical equipment.

FAQ · About this visit

Common questions about this visit

What happened during the July 22, 2022 survey of SUMMIT, THE?

This was a inspection survey of SUMMIT, THE on July 22, 2022. The surveyor cited 36 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at SUMMIT, THE on July 22, 2022?

Yes, 36 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Ensure residents have reasonable access to and privacy in their use of communication methods."

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.

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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.