Lake Montgomery Health And Rehabilitation Center

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to ensure the resident's representative was notified of the resident's refusal of medication administration for 1 of 4 residents, Resident #1, reviewed for medication administration.Findings include:Review of Resident #1's admission Data documented the resident was admitted on [DATE] with medical diagnoses to include type 2 diabetes mellitus with foot ulcer; difficulty in walking, not elsewhere classified; and non-pressure chronic ulcer of other part of right foot with necrosis of muscleReview of Resident #1's MDS (Minimum Data Set) Evaluation, quarterly assessment dated [DATE], documented the resident had a BIMS (Brief Inventory of Mental Status) Score of 09 out of 15, which indicated some cognitive impairment.Review of Resident #1's MAR (Medication Administration Record) for 11/01/2025 - 11/30/2025 read, HumaLOG KwikPen (an insulin pen) 100 UNIT/ML (100 units per milliliter) solution pen injector: Inject as per sliding scale: if [blood sugar reading]…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure resident care plans regarding advanced directives were updated for 1 of 4 residents, Resident #1, reviewed for accuracy of care plans.Findings include:Review of Resident #1's admission Data documented the resident was admitted into the facility on [DATE] with an Advanced Directive of Full Code status (if a resident is absent of life the health care team is to use all available and necessary life-saving measures to resuscitate).Review of Resident #1's Care Plan read, Focus: Advanced Directives: Resident has an established CPR [cardiopulmonary resuscitation] (Full Code) order in place. Date Initiated: [DATE]. Created on: [DATE].During an interview on [DATE] at 1:09 PM the DON (Director of Nursing) stated, I see that his [Resident #1] Care Plan was not updated. He came in as a Full Code, and he changed it in October to a DNR [Do Not Resuscitate]. During an interview on [DATE] at 5:14 PM the MDS LPN (Minimum Data Set Licensed Practical Nurse)…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interview and record review, the facility failed to ensure complete and accurate records for 1 of 4 residents, Resident #1, reviewed for medication administration. Findings include:Review of Resident #1's MAR (Medication Administration Record) for 11/01/2025 - 11/30/2025 read, HumaLOG KwikPen (an insulin pen) 100 UNIT/ML (100 units per milliliter) solution pen injector: Inject as per sliding scale: if [blood sugar reading] 151 - 200 = 2; 201 - 250 = 4; 251 - 300 = 6; 301 - 350 = 8; 351 - 400 = 10 Call MD, subcutaneously before meals and at bedtime for DM (diabetes mellites) - Start Date 09/08/2025 0630 (6:30 AM) -D/C (discontinue) Date 12/22/2025 1232 (12:32 PM). Documented for the Hours of 0630 [6:30 AM] dated 11/1/2025, 11/19/2025, and 11/30/2025 the MAR for BS [blood sugar] was documented NA (not applicable). Dated 11/24/2025 the MAR was blank. For the Hours of 1130 (11:30 AM) dated 11/13/2025, 11/16/2025, 11/19/2025, 11/20/2025, 11/25/2025, and 11/27/2025 the MAR was documented as NA. For the Hours of 1630 (4:30 PM) dated 11/25/2025 and 11/26/2025 the MAR documented NA.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review and interview, the facility failed to ensure resident assessments were accurate for 1 (Resident #19) of 3 residents reviewed for respiratory services.Review of Resident #19 Minimum Data Set (MDS) titled Quarterly dated 7/10/2025 documented resident did not use oxygen therapy.Review of Resident #19 vital task for oxygen saturations documented on 7/8/2025 at 12:53 PM oxygen via nasal cannula, on 7/7/2025 at 6:05 AM oxygen via nasal cannula, 7/5/2025 at 5:16 AM oxygen via nasal cannula, 7/4/2025 at 12:42 AM oxygen via nasal cannula, and 7/3/2025 at 3:38 AM oxygen via nasal cannula.Review of Resident #19 nurses notes dated 7/8/2025 read, O2 [oxygen] sats [saturation]: 97% Method: Oxygen via Nasal Cannula.Review of Resident #19 physician order dated 4/8/2025 read, Oxygen @ [at] 3 litters via nasal cannula for SOB [shortness of breath] no humidification as needed for SOB.During an interview on 7/31/2025 at 1:58 PM with Staff A MDS Licensed Practical Nurse (LPN) stated, [Resident #19's name] Section O for oxygen needs to be updated, the nurses were not documenting on…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure Preadmission Screening and Resident Review (PASRR) was accurately completed for 2 of 6 residents reviewed (Residents #11, and #19). Findings include: 1) Review of Resident #11’s admission record showed the resident was admitted on [DATE] with diagnoses including but not limited to residual schizophrenia (onset date: 3/26/2019), unspecified mood (affective) disorder (onset date: 3/26/2019), adjustment disorder with mixed anxiety and depressed mood (onset date: 3/26/2019), major depressive disorder (onset date: 1/31/2024), generalized anxiety disorder (onset date: 1/31/2024), paranoid schizophrenia (onset date: 3/26/2019), and other specified persistent mood disorders (onset date: 3/26/2019). Review of Resident #11’s PASSR dated 7/10/2025 did not show persistent mood disorder under mental illness or suspected mental illness under Section I: PASSR Screen Decision-Making. Review of Resident #11’s psychiatry subsequent note dated 7/1/2025 read,…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review and interview, the facility failed to ensure medications were administered as ordered by physician for 2 of 7 residents reviewed for medication management (Residents #5 and #11). Findings include: 1) Review of Resident #5's physician order dated 9/2/2024 read, Metoprolol Tartrate Oral Tablet 50 MG [Milligram] (Metoprolol Tartrate), Give 50 mg by mouth every 12 hours for Beta Blocker. Review of Resident #5's Medication Administration Record (MAR) for June 2025 for administration of Metoprolol Tartrate Tablet 50 mg showed code 4 (vitals outside of parameters for administration) was documented on 6/4/2025 at 9:00 PM for the blood pressure of 115/60 and pulse of 66, on 6/7/2025 at 9:00 PM for the blood pressure of 109/65 and pulse of 80, on 6/8/2025 at 9:00 PM for the blood pressure of 111/69 and pulse of 70, on 6/19/2025 at 9:00 PM for the blood pressure of 107/61 and pulse of 66, and on 6/21/2025 at 9:00 PM for the blood pressure of 111/69 and pulse of 62. Review of Resident #5's MAR for July 2025 for administration of Metoprolol Tartrate Tablet 50 mg showed…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation and interview, the facility failed to ensure accurate nurse staffing information was posted on a daily basis. Findings include: During an observation on 7/28/2025 at 9:39 AM, nurse staffing information dated 7/27/2025 was posted immediately after entering the residential area (Photographic evidence obtained). During an interview on 7/29/2025 at 2:39 PM, the Director of Nursing stated, The scheduler is the one responsible for updating the staff posting daily. She arrives around 6 AM and by 8 AM, the posting should be updated. During an interview on 7/31/2025 at 8:19 AM, the Scheduler stated, I will normally update the staff posting when I get to the facility that is around 8 to 8:30 AM. I had it ready in the backroom on Monday [7/28/2025] and was trying to still get the numbers correct during the morning routine. I don't have access to the census. I have to wait on payroll or the Business Office Manager. During an interview on 7/31/2025 at 12:45 PM, the Business Office Manager stated, I had no delays on Monday that I recall that would have not allowed me to…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review and interview, the facility failed to provide laboratory services to meet the needs of the residents for 1 of 5 residents reviewed for medication management (Resident #19). Findings include: Review of Resident #19's progress note dated 7/7/2025 at 5:19 PM read, Resident daughter came to nursing reporting that mother is hallucinating, talking to someone that is not there and thinking someone is watching here. Will notify MD [Medical Doctor] and Psych [Psychiatrist]. Review of Resident #19's psychiatry subsequent note dated 7/8/2025 read, Chief complaint: Depression, anxiety, mood disorder, psychosis, and Parkinson's disease. Reason for Today's encounter: Today I saw the patient as it was reported to me that patient is unstable requiring psychiatric assessment. History of present illness . Today I saw the patient as it was reported to me that patient is unstable requiring psychiatric assessment. As per collected information, staff reported increased anxiety. Patient come to front lobby and pray all the time. Dementia is persisting, but no other behaviors noted.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to ensure food was properly stored in 1 of 2 nourishment rooms. Findings include: During an observation of the nourishment room on C Hall on 7/28/2025 at 9:35 AM, there were two unlabeled and undated plastic bags containing unknown food items in the freezer. There was unlabeled and undated cloth lunch box containing unknown food item in the refrigerator drawer. During an interview on 7/28/2025 at 9:37 AM, the Dietary Manager stated the food should have been labeled and dated. Review of the facility policy and procedure titled Use and Storage of Food Brought in by Family or Visitors with the last review date of 1/31/2025 read, Policy: It is the right of the residents of this facility to have food brought in by family or other visitors, however, the food must be handled in a way to ensure the safety of the residents. Policy Explanation and Compliance Guidelines. 2. All food items that are already prepared by the family or visitor brought in must be labeled with content and dated.

Based on observation and interview, the facility failed to maintain a clean and homelike environment for residents (Photographic evidence obtained). The findings include: During an observation of laundry room on 4/10/2024 at 2:50 PM with the Maintenance Director, Director of Housekeeping and Laundry, and Staff C, Laundry Assistant, one of the two washing machines was not working. In the washing machine room, there were linen cans with no covers, a large buildup of garbage, debris, and lint behind the washing machines, a window screen propped on the floor next to the working washing machine with a large amount of garbage and debris around it, and on debris and lint on the air conditioning unit. In the lint area of Dryer #1 and Dryer #2, there was a large buildup of dust and lint. In the drum of Dryer #2, there was a large buildup of brown, melted, unidentified matter. Dryer #2's door did not latch. In the bottom of the clean linen cart, there was a buildup of garbage and debris. The carts in the dryer room which held the clean linens were uncovered. During an interview on 4/10/2024…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure nutritional interventions were provided in a timely manner for 1 of 6 residents reviewed for nutrition, Resident #4. The findings include: During an interview on 4/8/2024 at 10:27 AM, Resident #4 stated the food at the facility was cold and over seasoned and that she often asked for a substitute which was normally a sandwich. The resident stated she had lost weight since being admitted to the facility. Review of Resident #4's admission record showed the resident was admitted to the facility on [DATE] with diagnoses including diabetes, gastroesophageal reflux disease, and pressure injuries. Review of Resident #4's Minimum Data Set, dated [DATE] showed a Brief Interview of Mental Status score of 15, which indicated intact cognition. Review of Resident #4's care plan, last reviewed on 1/24/2024, showed the resident was at nutritional risk and was experiencing weight loss despite having a fair to good oral intake. Review of Resident…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.