All citations for Jerold Phelps Comm Hosp SNF

State inspectors check nursing homes that take Medicare or Medicaid against federal rules, usually about once a year, and also look into complaints. Each rule a home did not meet is a citation.

Back to Jerold Phelps Comm Hosp SNF

Last standard health inspection on record

September 12, 2025

Showing 26 to 50 of 61 citations

  1. No harm, with potential for more than minimal harm

    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.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0761, Pharmacy Service Deficiencies. Inspection of September 12, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (October 30, 2025).

  2. No harm, with potential for more than minimal harm

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

    Pattern (more than a few residents). CMS level E.

    Health citation F-0756, Pharmacy Service Deficiencies. Inspection of March 1, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 9, 2024).

  3. No harm, with potential for more than minimal harm

    Properly provide smoke detection systems in areas open to corridors.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0347, Smoke Deficiencies. Inspection of March 1, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 20, 2024).

  4. No harm, with potential for more than minimal harm

    Properly select, install, inspect, or maintain portable fire extinguishes.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0355, Smoke Deficiencies. Inspection of March 1, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 20, 2024).

  5. No harm, with potential for more than minimal harm

    Install corridor and hallway doors that block smoke.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0363, Smoke Deficiencies. Inspection of March 1, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 20, 2024).

  6. No harm, with potential for more than minimal harm

    Ensure proper usage of power strips and extension cords.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0920, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of March 1, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 20, 2024).

  7. No harm, with potential for more than minimal harm

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

    Pattern (more than a few residents). CMS level E.

    Health citation F-0638, Resident Assessment and Care Planning Deficiencies. Inspection of May 20, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (July 22, 2021).

  8. No harm, with potential for more than minimal harm

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

    Pattern (more than a few residents). CMS level E.

    Health citation F-0655, Resident Assessment and Care Planning Deficiencies. Inspection of May 20, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (July 22, 2021).

  9. No harm, with potential for more than minimal harm

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

    Pattern (more than a few residents). CMS level E.

    Health citation F-0656, Resident Assessment and Care Planning Deficiencies. Inspection of May 20, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (July 22, 2021).

  10. No harm, with potential for more than minimal harm

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

    Pattern (more than a few residents). CMS level E.

    Health citation F-0697, Quality of Life and Care Deficiencies. Inspection of May 20, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (July 22, 2021).

  11. No harm, with potential for more than minimal harm

    Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0609, Freedom from Abuse, Neglect, and Exploitation Deficiencies. Inspection of March 23, 2026. Found during a complaint inspection.

    The home gave a date the problem would be corrected (April 24, 2026).

  12. No harm, with potential for more than minimal harm

    Provide enough food/fluids to maintain a resident's health.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0692, Quality of Life and Care Deficiencies. Inspection of September 12, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (October 30, 2025).

  13. No harm, with potential for more than minimal harm

    Establish roles under a Waiver declared by secretary.

    Isolated (one or a few residents). CMS level D.

    Emergency preparedness citation E-0026, Emergency Preparedness Deficiencies. Inspection of September 12, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 26, 2025).

  14. No harm, with potential for more than minimal harm

    Have a complete alarm system manually initiated and initiated by fire sprinkler system connection.

    Isolated (one or a few residents). CMS level D.

    Fire safety citation K-0342, Smoke Deficiencies. Inspection of September 12, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 26, 2025).

  15. No harm, with potential for more than minimal harm

    Properly select, install, inspect, or maintain portable fire extinguishes.

    Isolated (one or a few residents). CMS level D.

    Fire safety citation K-0355, Smoke Deficiencies. Inspection of September 12, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 26, 2025).

  16. No harm, with potential for more than minimal harm

    Meet requirements for the use of electrical equipment.

    Isolated (one or a few residents). CMS level D.

    Fire safety citation K-0919, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of September 12, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 26, 2025).

  17. No harm, with potential for more than minimal harm

    Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0550, Resident Rights Deficiencies. Inspection of April 17, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (June 1, 2025).

  18. No harm, with potential for more than minimal harm

    Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0609, Freedom from Abuse, Neglect, and Exploitation Deficiencies. Inspection of April 17, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (June 1, 2025).

  19. No harm, with potential for more than minimal harm

    Ensure that residents are fully informed and understand their health status, care and treatments.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0552, Resident Rights Deficiencies. Inspection of March 1, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 9, 2024).

  20. No harm, with potential for more than minimal harm

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

    Isolated (one or a few residents). CMS level D.

    Health citation F-0636, Resident Assessment and Care Planning Deficiencies. Inspection of March 1, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 9, 2024).

  21. No harm, with potential for more than minimal harm

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

    Isolated (one or a few residents). CMS level D.

    Health citation F-0689, Quality of Life and Care Deficiencies. Inspection of March 1, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 9, 2024).

  22. No harm, with potential for more than minimal harm

    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.

    Isolated (one or a few residents). CMS level D.

    Fire safety citation K-0222, Egress Deficiencies. Inspection of March 1, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 20, 2024).

  23. No harm, with potential for more than minimal harm

    Have a complete alarm system manually initiated and initiated by fire sprinkler system connection.

    Isolated (one or a few residents). CMS level D.

    Fire safety citation K-0342, Smoke Deficiencies. Inspection of March 1, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 20, 2024).

  24. No harm, with potential for more than minimal harm

    Inspect, test, and maintain automatic sprinkler systems.

    Isolated (one or a few residents). CMS level D.

    Fire safety citation K-0353, Smoke Deficiencies. Inspection of March 1, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 20, 2024).

  25. No harm, with potential for more than minimal harm

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

    Isolated (one or a few residents). CMS level D.

    Fire safety citation K-0918, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of March 1, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 20, 2024).

Source: CMS Provider Information, Fire Safety Deficiencies, Health Deficiencies, Citation Code Look-up, data as of September 30, 2026. Inspection results describe the home at the time of each inspection.