| Facility failed to meet the following Requirement(s): | Corrected Date | Level of Harm | Residents Affected |
| The administrator shall maintain on the premises an individual personnel record on each facility employee, which shall include the following:
(I) Written statement signed by a licensed physician or physician ' s designee indicating the person can work in a long-term care facility and indicating any limitations; III
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3/1/2022
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| The facility shall maintain a record in the facility for each resident, which shall include the following:
(A) Admission information including the resident ' s name; admission date; confidentiality number; previous address; birth date; sex; marital status; Social Security number; Medicare and Medicaid numbers (if applicable); name, address and telephone number of the resident ' s physician and alternate; diagnosis, name, address and telephone number of the resident ' s legally authorized representative or designee to be notified in case of emergency; and preferred dentist, pharmacist and funeral director; III
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3/1/2022
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