Mosholu Parkway Nursing & Rehabilitation Center
3356 Perry Avenue, Bronx, NY 10467 · For profit - Corporation · 122 certified beds · (718) 655-3568 Medicare & Medicaid certified
The public record raises real questions here. Weigh the concerns below carefully.
- no federal fines or payment denials on record
- it has citations for its abuse-prevention policies, restraint use, or reporting and investigating of allegations (F0604, F0609, F0610) — cited below the harm level, meaning inspectors found the process wanting but did not find a resident harmed
- a high number of inspection citations overall (25) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
- its facility-reported quality-measure score sits well above its independent inspection score
- its independent health-inspection rating is low (2/5)
- its payroll-based staffing rating is low (2/5)
- its last standard health inspection was over 2 years ago — the star rating may not reflect current conditions
One thing this read cannot see: what residents and families actually experience day to day. Public data misses the feel of a place — visit unannounced, ideally at a mealtime or on a weekend, talk to staff and families, and ask your tour questions.
A plain-English summary of the public record below — not a rating, ranking, or recommendation. We take no money from any facility.
| Health inspectionSurveyor-assigned, ranked within your stateInspector-verified | 2 of 5 |
| StaffingFrom payroll records (PBJ) | 2 of 5 |
| Quality measuresSelf-reported by the facility | 5 of 5 |
Worth a closer look. This home's quality-measure rating runs 3 stars above its independent health-inspection score. The inspection is done by state surveyors; the quality-measure score leans on data the facility reports about itself — so a gap this large is worth reading the inspection record for.
Location & what’s nearby
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Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.
Quality measures — how residents actually fare
| Overall quality measures | 5 of 5 |
| Long-stay residentspeople who live here | 4 of 5 |
| Short-stay residentsrehab / post-hospital | 5 of 5 |
Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.
Trend — is this home getting better or worse?
Over 2025-02 to 2026-06, this home’s CMS overall rating improved from 1 to 2 stars. From monthly CMS archive snapshots.
Horizontal axis runs 2025-02 to 2026-06. That is where CMS’s monthly archive ends, so the right-hand edge of each line is that month — not today.
See all quality measures vs. state & national benchmarks
| Measure | This home | State avg | Typical state | vs typical state |
|---|---|---|---|---|
| Long-stay residents whose need for help with daily activities increased | 11.9% | 14.1% | 15.4% | better |
| Long-stay residents who lose too much weight | 5.2% | 5.8% | 5.4% | typical |
| Long-stay residents with a catheter left in their bladder | 1.6% | 0.5% | 0.9% | worse |
| Long-stay residents with a urinary tract infection | 1.0% | 1.3% | 2.0% | better |
| Long-stay residents with depressive symptoms | 57.0% | 19.5% | 6.5% | worse than state‡ — see note marked double-dagger below the table |
| Long-stay residents who were physically restrained | 0.0% | 0.2% | 0.1% | better |
| Long-stay residents with falls causing major injury | 3.3% | 3.1% | 3.3% | typical |
| Long-stay residents whose ability to walk worsened | 4.7% | 12.5% | 16.1% | better |
| Long-stay residents on antianxiety or hypnotic medication | 1.9% | 13.2% | 18.9% | better |
| Long-stay residents given the seasonal flu vaccine | 66.4% | 95.3% | 95.3% | worse |
| Long-stay residents with pressure ulcers | 7.0% | 6.5% | 4.7% | worse |
| Long-stay residents with worsening bladder/bowel control | 32.8% | 19.5% | 21.2% | worse |
| Long-stay residents who got an antipsychotic medication§ — see the note below the table | 12.6% | 13.7% | 17.1% | better |
| Short-stay residents who newly got an antipsychotic medication | 3.6% | 1.2% | 1.4% | worse |
| Short-stay residents given the seasonal flu vaccine | 34.4% | 78.8% | 79.4% | worse |
| Short-stay residents rehospitalized after admission | 10.7% | 20.6% | 22.6% | better |
| Short-stay residents with an outpatient ER visit | 1.7% | 9.6% | 12.0% | better |
| Long-stay hospitalizations per 1,000 resident days | 2.52 | 1.70 | 1.67 | worse |
| Long-stay outpatient ER visits per 1,000 resident days | 0.68 | 1.36 | 1.80 | better |
‡ On this measure the state average is at least twice (or half) the typical state — a gap that size is usually how the state codes and reports the measure, not how its homes actually perform. Against a benchmark this state does not sit on, a “vs typical state” verdict would mostly be measuring the state, so we compare this home with its own state instead and show both averages.
§ Antipsychotics carry an FDA boxed warning — they raise the risk of death in older people with dementia-related psychosis, and are not approved for that use. So this measure is partly a read on whether a home sedates residents instead of staffing for them. But read a low rate carefully in both directions: CMS excludes residents coded with schizophrenia (and Tourette's or Huntington's) from this measure, and federal auditors have found implausible increases in schizophrenia coding since the measure was published — so a very low rate can reflect recoding rather than less prescribing. Ask the home what share of its residents carry a schizophrenia diagnosis, and how it handles behavioral symptoms without medication.
CMS quality measures, as Care Compare shows them. For most rows lower is better (fewer falls, ulcers, hospitalizations); vaccination rates are the exception. Not every row is risk-adjusted. CMS adjusts some measures for resident mix, but falls with major injury, antipsychotic use, physical restraints and the vaccination rates are unadjusted rates — so a home caring for heavier or more behaviorally complex residents can look worse on them without providing worse care. The “typical state” column is the median of the 50 state averages — not a national average of all homes. We use it because a plain average across homes is pulled badly off course by a few states’ reporting habits (long-stay depressive symptoms is the clearest case: Illinois codes it several times higher than most states, which alone lifted the all-homes figure to about twice what a typical state records). The median of state averages resists that — but it does weigh every state equally, so a large state counts no more than a small one, and it is a benchmark of our construction rather than a CMS-published figure. better/worse means the home differs from that benchmark by more than 10% of it; closer than that reads typical. CMS does not publish how many residents each measure covers, and the counts are often small — a single resident can move a rate by several points — so treat small gaps as noise. These come from data the facility reports, so weigh them against the independent inspection record above.
Short-stay rehab — if you are coming here from a hospital
Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.
Met the expected recovery: 81.6% of this home’s Medicare short-stay residents left it at or above the ability to care for themselves and move around that CMS predicted for them, across 38 stays in Oct 2024–Sep 2025. The median of the 11,061 homes CMS publishes this for is 56.6%. Read it beside the getting-home figure, not instead of it: unlike the two measures above, CMS makes no better-or-worse call on this one and publishes no confidence interval for it, so this is a comparison and not a verdict — but it is the short-stay measure that separates homes most, and the one to ask about.
Therapy staffing: this home’s payroll records show 0.27 therapist hours per resident per day in 2026Q1 — more than 41% of the 13,892 homes that report any therapy hours at all.
Weekend therapy: weekend therapy hours are 23% of this home’s weekday level — it runs some therapy at the weekend, at a lower level than on weekdays. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.
This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.
See every short-stay measure CMS publishes for this home
| Measure | This home | U.S. median | Period covered | CMS’s call |
|---|---|---|---|---|
| Got home and stayed homeRate of successful return to home or community from a SNF | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF | 9.6%CMS range 6.9–14.2 | 10.7% | Oct 2022–Sep 2024 | no different from U.S. |
| Met the expected recoveryPercentage of residents who are at or above an expected ability to care for themselves and move around at discharge | 81.6% | 56.6% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Self-care at dischargePercentage of residents who are at or above an expected ability to care for themselves at discharge | 65.8% | 52.8% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge | 71.0% | 50.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Medication problems followed upPercentage of residents whose medications were reviewed and who received follow-up care when medication issues were identified | 96.4% | 98.7% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Medication list to the next providerPercentage of residents where the SNF provided a current medication list to the next health care setting | 87.0% | 100.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Medication list to the familyPercentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Falls with major injuryPercentage of SNF residents who experience one or more falls with major injury during their SNF stay | 1.8% | 0.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsened | 5.4% | 1.9% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalization | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs | 1.14 | 1.02 | Oct 2022–Sep 2024 | CMS makes no comparison for this measure |
From the CMS Skilled Nursing Facility Quality Reporting Program — Medicare short-stay outcomes, which is a different dataset from the long-stay quality measures above and describes a different set of residents. Where CMS risk-adjusts a measure we show its adjusted rate, and the CMS range beside it is the confidence interval CMS publishes: a home whose range is wide is a home with few stays, where one patient moves the number several points. Read the period column. These measures do not share a window — the claims-based ones (getting home, readmission, spending) lag by a year or more, because a stay has to finish and its claims settle before it can be counted. CMS’s call is CMS’s, not ours: it is the only place anyone tests whether this home differs from the national rate at all, and most homes on most measures do not. Two caveats on it. CMS tests only three of these measures — getting home, readmission, and infections that led to hospital; on the other nine it publishes a rate and no comparison, and rather than compute a verdict CMS declined to make, we say so in the column. And on readmission almost every home in the country lands on “no different”, so that row separates homes far less than getting-home does — which is why met the expected recovery, a measure CMS does not test but which spreads across the whole range, is called out above the table rather than left in this list. The U.S. median column is our own, taken across every home CMS publishes that measure for in this same file; it is not a CMS-published benchmark. Homes CMS gives no rate for are left out of it rather than counted as zero. Medicare spending per stay is a ratio, not a percentage — 1.00 means this home’s Medicare spending for a stay matched the national figure CMS compares it against, and it measures cost to Medicare, not quality of care.
Staffing
How full it usually is: this home is certified for 122 beds and averages 118.5 residents a day — about 97% occupied, or roughly 4 beds typically open. It runs essentially full — expect a waiting list. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.
Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 3.20 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.45 is below the 0.55-hour RN benchmark and nurse-aide staffing of 2.16 is below the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.
Weekend coverage: total nurse staffing is 2.76 hrs/resident/day on weekends vs 3.38 on weekdays — 18% thinner on weekends. RN hours go from 0.52 to 0.30 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)
This home’s total nursing-staff turnover of 44% is about the same as the national median of 45%. 1 administrator has left in the past year.
Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.
Inspection trend
Deficiencies are more than at the previous inspection — worsening. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.
This trend is not current. The most recent of these two inspections was over 2 years ago; the arrow describes what inspectors found then, not what the home is like now.
Inspection deficiencies
State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.
Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.
25 citations, most serious first. The 10 most serious are shown; the remaining 15 are one tap away and print in full.
- Potential for harm · Dcited before2025-07-17 · tag F0609 — failed to report abuse allegations — isolatedTimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, and interviews conducted during an Abbreviated Survey (NY00373522), the facility did not ensure that all alleged violations involving abuse, neglect, exploitation, mistreatment, or misappropriation of resident property were reported immediately, but not later that two (2) hours after the allegation is made, if the events that caused the allegation involved abuse or resulted in serious bodily injury, or not later than 24 hours if the events that caused the allegation do not involved abuse and do not involve serious bodily injury, to the administrator of the facility and to other officials (including to the State Agency). This was evident for one (1) out of three (4) residents (Resident #2) sampled. Specifically, Resident #2 was observed sitting on the floor close to their bed with their rolling walker close by. Milk was spilled from an opened container that was in Resident #2's basket (attached to rolling walker) at approximately 4:25 PM on 02/22/2025. Resident #1 had no visible injuries.…
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.
- Potential for harm · D2025-07-17 · tag F0684 — failed to provide proper treatment and quality of care — isolatedProvide appropriate treatment and care according to orders, resident’s preferences and goals.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and interviews conducted during an abbreviated survey (NY00370671 and NY00373522), the facility did not ensure that a resident received the necessary care and treatment in a timely manner and in accordance with professional standards of practices. This was evident in two (2) out of five (5) residents (Resident #1 and Residents #2) sampled. Specifically, 1.) on 01/30/2025 at 12 midnight Certified Nursing Assistant #1 observed Resident #1 at the sink in their room holding their right hand under the cold water. According to Certified Nursing Assistant #1, they observed Resident #1's right hand to be a little red but they did not report it to the nurse. At 4:30 AM on 01/30/2025, Certified Nursing Assistant #2 observed Resident #1 at the sink in their room holding their right hand under the cold water. Certified Nursing Assistant #2 stated that Resident #1's right was bloody, swollen, and red. Registered Nurse Supervisor #1 was notified, and Resident #1 was transferred to the…
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.
- Potential for harm · D2024-11-15 · tag F0604 — failed to not use physical restraints improperly — isolatedEnsure that each resident is free from the use of physical restraints, unless needed for medical treatment.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, record review and interviews during the abbreviated survey (NY00312367), the facility failed to ensure that a resident was treated with dignity included being free from physical or chemical restraints imposed for purposes of discipline or convenience and that are not required to treat the resident's medical symptoms. This was evident in one out of three residents reviewed (Resident #1). Specifically, on 03/09/2023 at approximately 8:39 AM, Physical Therapist #1 observed Resident #1 in their room sitting in the wheelchair with a bed sheet wrapped around their waist and tied to the wheelchair. Registered Nurse Supervisor #1 assessed Resident #1 and there were no visible injuries. The findings included: The facility policy titled Restraint Free Facility with the revised date 03/01/2024, documented the purpose of this policy is to affirm the facility's commitment to being a restraint-free facility. The center is dedicated to ensuring the dignity, safety, and well-being of all residents by eliminating the use of chemical and physical restraints and implementing…
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.
- Potential for harm · F2024-08-16 · tag F0812 — failed to store, cook, and serve food safely — widespreadProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and interviews conducted during the Recertification Survey from 8/12/2024 to 8/16/2024, the facility did not ensure that food was stored, prepared, distributed and served in accordance with professional standards for food service safety. This was evident during the kitchen and food service observations. Specifically, 1.) The dairy and meat walk-in refrigerators contained opened cans and undated, unlabeled, expired food items. 2.) There were no thermometers located in the walk-in and ice cream freezers. 3.) The unit refrigerator temperatures were not maintained, and contained spilled, spoiled, undated and unlabeled food items. 4.) During meal service, staff was observed handing resident's food with bare hands. The findings are: The facility's policy and procedure titled Refrigerator Storage with revision date of 1/1/2018 documented that standards must be followed to ensure the proper storage of refrigerated items. Each refrigerator must have a thermometer that is easily…
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.
- Potential for harm · F2024-08-16 · tag F0814 — failed to dispose of garbage properly — widespreadDispose of garbage and refuse properly.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, record review, and interviews conducted during the Recertification Survey from 08/12/2024 to 08/16/2024, the facility did not ensure that the garbage storage areas were maintained in sanitary condition. This was evident during the Kitchen Observation. Specifically, garbage was not properly contained outside of the facility or disposed of properly. The outside garbage dumpsters were uncovered, and the trash can inside the kitchen was not covered. The findings are: The facility policy and procedure titled Food-Related Garbage and Refuse Disposal, revised January 2024, documented food-related garbage, and refuse are disposed of in accordance with current state laws. All food waste shall be kept in containers. All garbage and refuse containers are provided with tight- fitting lids or covers and must be kept covered when stored or not in continuous use. Garbage and refuse containers will be emptied daily and as needed. Outside dumpsters provided by garbage pick up services will be kept closed and free of surrounding litter On 08/14/24 at 11:00 AM, An observation of…
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.
- Potential for harm · F2024-08-16 · tag F0925 — failed to control pests — widespreadMake sure there is a pest control program to prevent/deal with mice, insects, or other pests.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review and staff interview conducted during the Recertification Survey from 08/12/2024 to 08/16/2024, the facility did not maintain an effective pest control program so that the facility is free of pests and rodents. This was evident during the kitchen observation. Specifically, multiple dead cockroaches, water bugs, spiders and silverfish were observed in the food storage room. The findings include but are not limited to: The facility policy titled Pest Control with a revision date of January 2024, documented that the facility shall maintain an effective on-going pest control program to keep the building free of insects and rodents. Pest control services are provided by JB Pest Control. An unsigned document titled Terms and Conditions of JB Pest Control Service Agreement, dated January 1, 2019, documented weekly servicing of the kitchen, dining areas, dietary and storage rooms with chemicals and baits. Glue boards will be refilled as needed. All areas serviced will be logged. This…
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.
- Potential for harm · E2024-08-16 · tag F0880 — failed to prevent and control infections — patternProvide and implement an infection prevention and control program.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and interviews conducted during the Recertification survey from 08/12/2024 to 08/16/2024, the facility did not ensure that infection control prevention practices and procedures were maintained to provide a safe and sanitary environment to help prevent the development and transmission of communicable diseases and infections. Specifically. Enhanced Barrier Precautions were not maintained 1) during wound care, 2) during foley catheter care and 3) during care of a resident with central venous catheter insertion. This was evident in 3 out of 27 sampled residents, (Resident #36,42, and #218). The findings are but not limited to: The Centers for Medicare and Medicaid Services (CMS) memo titled Center for Clinical Standards and Quality/Quality, Safety & Oversight Group. Ref: QSO-24-08-NH dated 03/20/2024 documented Enhanced Barrier Precautions recommendation now includes using enhanced barrier precautions for residents with chronic wounds or indwelling medical devices during…
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.
- Potential for harm · D2024-08-16 · tag F0561 — failed to honor residents' choices — isolatedHonor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interviews conducted during the Recertification survey from 08/12/2024 to 08/16/2024, the facility did not ensure that it promoted and facilitated resident self-determination by supporting resident choice. Specifically, residents' bathing preferences were not honored. This was evident for one of the residents reviewed for Choices out of 27 sampled residents (Resident #76). The findings are: The facility's undated policy and procedure, Bath, Shower/Tub, documented that the facility provides showers two to three times a week and as requested (preference) by the resident/designated representative. Resident #76 was admitted with the diagnoses that include Hypertension and Depression. The quarterly Minimum Data Set assessment dated [DATE] documented Resident #76's cognition as severely impaired and never/rarely made decisions. The resident requires substantial/maximal assistance with showering/bathing self. On 08/13/2024 at 9:10 AM, Resident #76's family representative was interviewed and…
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.
- Potential for harm · Dcited before2024-08-16 · tag F0609 — failed to report abuse allegations — isolatedTimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews, observations and record reviews made during the Recertification and Complaint Survey (NY00330894) from 8/12/24 - 8/16/24 the facility did not ensure that all alleged violations including injuries of unknown origin were reported immediately but not later than 2 hours if the event that caused the allegation involved abuse or caused serious bodily injury. Specifically, a resident (Resident #12) sustained a scratch and possible bruise that were not reported to the New York State Department of Health. The findings are: The facility's policy and procedure entitled Abuse Prevention, last reviewed 12/2018, documents that each covered individual must report immediately but not later than 2 hours after forming the suspicion if the events that cause the suspicion result in serious bodily injury or not later than 24 hours if the events that cause the suspicion do not result in serious bodily injury. Resident #12 was admitted to the facility on [DATE] with diagnoses including Osteoporosis and Alzheimer's…
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.
- Potential for harm · D2024-08-16 · tag F0688 — failed to keep residents mobile / prevent decline — isolatedProvide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record reviews and interviews conducted during the Recertification survey from 8/12/24 to 8/16/24, the facility did not ensure that a resident with limited range of motion received appropriate treatment and services to prevent a further decrease in range of motion. This was evident for 1 (Resident # 16) of 2 residents reviewed for Position/Mobility out of a sample of 27 residents. Specifically, Resident # 16 had an active Physician order for bilateral hand gauze to both hands to prevent flexion contracture at the digits, to be worn at all times and remove for Activities of Daily Living (ADL) and skin check. Both hands were observed without the hand gauze on multiple occasions. The findings are: The policy titled Adaptive Device effective 1/15/2020 documents it is the policy of the facility to provide proper adaptive device such as splint, orthosis to maintain or improve residents functional well being and or prevent or slow down the disease process. Resident # 16 diagnoses include:…
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.
Show the remaining 15 citations
- Potential for harm · Dcited before2024-08-16 · tag F0842 — failed to keep accurate, complete medical records — isolatedSafeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and interview conducted during a Recertification Survey from 08/12/2024 to 08/16/2024 the facility did not ensure that medical records were maintained in accordance with accepted professional standards and practices and that they were complete and accurately documented for each resident. This was evident for 1 (Resident #42) of 1 resident reviewed for Dialysis out of 27 sampled residents. Specifically, Resident #42 had a right upper chest central venous catheter for hemodialysis, but the documentation showed an AV Fistula. The findings include: The facility policy and procedure titled Charting and Documentation, last revised 01/05/2024, states that all services provided to the resident, progress towards the care plan goals, or any changes in the resident's medical, physical, functional, or psychosocial condition shall be documented on the resident's medical record. Resident #42 was admitted with a diagnosis of End-Stage Renal Disease (ESRD) and Diabetes Mellitus. The…
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.
- Potential for harm · D2024-08-16 · tag F0924 — isolatedPut firmly secured handrails on each side of hallways.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, interview, and record review conducted during the recertification survey from 08/12/2024 to 08/16/2024, the facility did not ensure handrails were firmly affixed and secured to the wall. This was evident for 1 (Unit #2) of 4 resident units observed during the environmental tour. Specifically, 2 sections of handrails were observed loose and not fully connected to the wall in the hallway of Unit 2. The findings are: Policy and Procedure titled Homelike Environment which is undated documents residents are provided with a safe environment. During multiple observations on Unit #2 between 08/12/2024 at 10:00 AM to 08/15/2024 at 1:00 PM, a handrail in the hallway near the elevator had 2 sections that were loose and not fully linked at a joint connection. There was no documented evidence of the loose handrail was reported in the Maintenance Logbook from December 2023 to August 15, 2024. On 08/15/2024 at 10:45 AM, Certified Nursing Assistant #1 was interviewed and stated they call the maintenance worker when something needs to be fixed and was not aware of a Maintenance…
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.
- Potential for harm · E2024-08-16 · tag F0656 — failed to write and follow a full care plan — patternDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interviews conducted during the Recertification and Complaint (NY00330928, and NY00330894) Survey from 08/12/2024 to 08/16/2024, the facility did not ensure a person-centered comprehensive care plan was developed and implemented to meet a resident's needs. This was evident for 2 of 3 residents (Resident #76, and #85) reviewed for care planning out of 27 total sampled residents. Specifically, 1) A comprehensive care plan related to abuse was not developed and implemented for Resident #76 following a resident to resident altercation, and 2) A comprehensive care plan was not developed and implemented to address Resident #85 insulin use. The findings are. The facility's undated policy and procedure titled Care Plans, Comprehensive Person - Centered documented that a comprehensive person-centered care plans that include measurable objectives and time frame to meet resident physical psychosocial and functional needs is developed and implemented for each resident. 1) Resident #76 was admitted…
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.
- Potential for harm · Dcited before2024-08-16 · tag F0610 — failed to investigate and act on abuse reports — isolatedRespond appropriately to all alleged violations.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews, observations and record reviews made during the Recertification and Complaint Survey (NY00330894) from 8/12/24 to 8/16/24 the facility did not ensure that an alleged of abuse was thoroughly investigated. Specifically, a resident (Resident #12) with a reported injury of unknown origin had only one written statement gathered from staff and no written investigation summary. The findings are: The facility's policy and procedure entitled Investigating Unexplained Injuries, last reviewed 12/2018, documents that a listing of all personnel including consultants, contract employees, visitors, family members etc. who have had contact with the resident during the past 24-48 hours will be compiled and provided to the person conducting the investigation. Resident #12 was admitted to the facility on [DATE] with diagnoses including Osteoporosis, Repeated Falls and Alzheimer's Disease. A Nursing progress note dated 01/01/2024 at 4:13 PM documents the resident was observed with a linear scratch across their…
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.
- Potential for harm · Dcited before2024-08-16 · tag F0657 — failed to keep the care plan current — isolatedDevelop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record reviews and interviews made during the Recertification Survey from 8/12/24 to 8/16/24, the facility did not ensure that a person-centered comprehensive care plan was reviewed and revised to accurately reflect a resident's current status. Specifically, a resident with a new skin break (Resident #12) did not have their Skin Integrity Care Plan updated to reflect the change. The findings are: Resident #12 was admitted to the facility on [DATE] with diagnoses including Osteoporosis, Diabetes and Alzheimer's Disease. A Skin Integrity Care Plan was initiated for the resident on 09/19/2018 with interventions including: completing skin assessments, monitoring resident's skin during care, encouraging fluid intake and food consumption, keeping skin clean and dry, arranging podiatry consults, providing pressure relieving mattress and devices when out of bed, and applying barrier cream. A Nursing Note dated 01/01/2024 at 4:13 PM documents that Resident #12 was observed with a linear scratch across their left…
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.
- Potential for harm · D2024-08-16 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolatedEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews, observations and record reviews made during the Recertification and Complaint(NY00326358) survey from 8/12/24 to 8/16/24, the facility did not ensure that each resident received adequate supervision to prevent accidents. Specifically, on 10/18/2023, a resident (Resident #99) eloped from the facility. The findings are: The facility's policy and procedure entitled Wandering Resident/Elopement, last reviewed 04/20/2023, states that each resident will be assessed for wandering behavior and elopement potential on admission. The receptionist monitors the front door 24 hours a day. The front door is kept locked and can be opened by reception only. If the receptionist leaves the front desk for any reason or any period of time, a trained replacement employee must be stationed at the front desk. The reception person must assure that all visitors sign in and out in the designated log book at the reception area. Pictures of residents at risk are taken by nursing staff and posted at the front desk.…
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.
- Potential for harm · D2022-09-01 · tag F0582 — isolatedGive residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews and record review conducted during the recertification survey from 8/25/22 to 9/1/22, the facility did not ensure resident were provided with a Skilled Nursing Facility (SNF) Advanced Beneficiary Notice of Non-coverage (ABN) at the termination of Medicare Part A benefits. This was evident for 2 (Residents #54 and #94) of 3 residents reviewed for Skilled Nursing Facility Beneficiary Protection Notification out of a total sample of 27 residents. Specifically, 1) Resident #54 remained in the facility after being discharged from skilled rehabilitation services and was not provided with a SNFABN; and 2) Resident #94 remained in the facility after being discharged from skilled rehabilitation services and was not provided with a SNFABN. The findings are: The facility policy titled Medicare Policy & Procedure last revised 7/2022, documented the clinical disciplines identify residents who are covered by Medicare Part A and Rehab/Nursing Minimum Data Set 3.0 (MDS) are responsible for resident's SNFABN…
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.
- Potential for harm · Dcited before2022-09-01 · tag F0609 — failed to report abuse allegations — isolatedTimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interviews conducted during the Recertification and Complaint (NY00275338) Survey, the facility did not ensure that an allegation of abuse involving an injury of unknown origin was reported to the New York State Department of Health (NYSDOH) immediately, but no later than 2 hours, after the allegation was made. This was evident for 1 (Resident #264) of 6 residents investigated for accidents out of 27 sampled residents. Specifically, the facility did not report Resident #264's abrasion to the back of their head, an injury of unknown origin, to the NYSDOH. The findings are: The facility policy titled Accident and Incident-Investigating and Reporting dated 04/2018 documented the Administrator/Director of Nursing (DON) will report injuries of unknown origin to the NYSDOH within 2 hours. Resident #264 had diagnoses hypertension and Alzheimer's disease. The Minimum Data Set 3.0 (MDS) dated [DATE] documented Resident #264 was severely cognitively impaired, exhibited wandering behavior daily,…
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.
- Potential for harm · Dcited before2022-09-01 · tag F0610 — failed to investigate and act on abuse reports — isolatedRespond appropriately to all alleged violations.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interviews conducted during the Recertification and Complaint (NY00275338) survey, the facility did not ensure that all allegations of abuse, including injuries of unknown origin, were thoroughly investigated. This was evident for 1 (Resident #264) of 6 residents investigated for accidents out of 27 sampled residents. Specifically, there was no documented evidence an investigation was conducted when Resident #264 sustained an abrasion to the back of their head. The findings are: The facility policy titled Abuse Prohibition-Prevention and Reporting dated 04/2018 documented investigations of any incident will be completed within five (5) days of the first report. Occurrences of unknown origin are investigated by the Director of Nursing and Nursing Supervisor. Resident #264 had diagnoses hypertension and Alzheimer's disease. The Minimum Data Set 3.0 (MDS) dated [DATE] documented Resident #264 was severely cognitively impaired, exhibited wandering behavior daily, and required the extensive…
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.
- Potential for harm · Dcited before2022-09-01 · tag F0657 — failed to keep the care plan current — isolatedDevelop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Resident #16 Based on observation, record review, and interviews conducted during the rectification survey, the facility did not ensure that Comprehensive Care Plans (CCP) were reviewed and revised by the interdisciplinary team (IDT). This was evident for 1 (Resident #16) of 1 resident(s) reviewed for urinary catheter and 1 (Resident #264) of 6 residents reviewed for accidents out of 27 sampled residents. Specifically, (1) the CCP related to bladder incontinence was not revised to address Resident #16's Foley catheter (FC) use; and (2) the CCP related to falls/accidents was not revised following Resident #264's abrasion to the back of their head. The findings are: The facility policy titled CCP dated 01/2010 documented the facility will develop CCPs are updated as needed: for example, as conditions change, goals are met, interventions are determined to be ineffective, or as specific treatable causes related problems for monitoring progress. (1) Resident #16 had diagnoses which include malignant neoplasm of…
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.
- Potential for harm · D2022-09-01 · tag F0756 — failed to review each resident's drug regimen — isolatedEnsure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and staff interviews conducted during a recertification survey from 8/25/22 to 9/01/22, the facility did not ensure the attending physician documented in the resident's medical record the identified pharmacy irregularity and action taken , if any, to address it. This was evident for 1 (Resident #77) of 5 residents reviewed for unnecessary medication out of 27 sampled residents. Specifically, the Medical Doctor (MD) did not act upon a pharmacy reccomendation for Resident #77 to receive BP monitoring. The findings are: Resident # 77 had diagnoses of hypertension and diabetes mellitus (DM). The Minimum Data Set 3.0 (MDS) assessment dated [DATE] documented Resident #77 had severely impaired cognition. Medical Doctor Order (MDO) dated 6/25/22 documented Resident #77 was ordered to receive Metoprolol Tartrate 25 mg once daily for hypertension and have vital signs, including BP, monitored every shift for 3 days. The BP Log documented BP monitoring for Resident #77 each shift from…
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.
- Potential for harm · D2022-09-01 · tag F0757 — failed to avoid unnecessary drugs — isolatedEnsure each resident’s drug regimen must be free from unnecessary drugs.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and staff interviews conducted during a recertification survey from 8/25/22 to 9/01/22, the facility did not ensure a resident was adequately monitored for efficacy and adverse effects while receiving blood pressure (BP) medication. This was evident for 1 (Resident #77) of 5 residents reviewed for unnecessary medication out of 27 sampled residents. Specifically, Resident #77 received Metoprolol Tartrate 25mg daily as per Medical Doctor Order (MDO) without BP monitoring. The findings are: The facility policy titled BP dated 3/1998 documented BP will be taken in accordance with the resident's plan of care and recorded in the resident's medical record. Resident # 77 had diagnoses of hypertension and diabetes mellitus (DM). The Minimum Data Set 3.0 (MDS) assessment dated [DATE] documented Resident #77 had severely impaired cognition. MDO dated 6/25/22 documented Resident #77 was ordered to receive Metoprolol Tartrate 25 mg once daily for hypertension and have vital signs,…
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.
- Potential for harm · Dcited before2022-09-01 · tag F0842 — failed to keep accurate, complete medical records — isolatedSafeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interviews conducted during a Recertification Survey from 8/25/22 to 9/01/22, the facility did not ensure medical records were complete and accurate in accordance with professional standards and practice. This was evident for 2 (Resident #77 and #76) of total sampled residents. Specifically, 1) there was no documented evidence a Health Shake 180 ml was offered to Resident #77 twice daily (BID) as ordered by the Medical Doctor (MD); and, 2) nursing staff documented Resident #76 had a left wrist wanderguard (WG) and Resident #76 was observed on multiple occasions with right ankle WG. The findings are: The facility policy titled Nutritional Care dated 7/11 documented residents receive nourishments twice daily according to prescription. The undated facility policy titled Wandering Resident/Elopement documented an alarm device will be placed on the resident to audibly alert staff of any attempts by the resident to exit exterior doors. 1) Resident # 77 had diagnoses of cerebrovascular…
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.
- Potential for harm · Dcited before2019-11-06 · tag F0610 — failed to investigate and act on abuse reports — isolatedRespond appropriately to all alleged violations.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record review conducted during the recertification survey, the facility did not ensure that an incident involving a resident was thoroughly investigated to rule out abuse. Specifically, the facility did not initiate an investigation after a resident was found with a foreign object in his anal cavity (Resident #73). This was evident for 1 of 1 resident reviewed for Abuse (Resident #73). The findings are: A facility policy and procedure related to Occurrence Reporting for residents and dated 2/26/16 documented that an occurrence is an unplanned event which results in any type of injury or has the potential to cause injury to a resident. The documented procedure is for the unit charge nurse to identify when an occurrence occurs and notify the Nursing Supervisor and request an Occurrence Report. The Registered Nurse (RN) Supervisor then obtains the report from the Nursing Office and assess the resident. Resident #73 was admitted to the facility on [DATE] and has a diagnosis of…
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.
- Potential for harm · D2019-11-06 · tag F0640 — isolatedEncode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview during the recertification survey, the facility did not ensure that a Minimum Data Set (MDS) 3.0 was electronically transmitted to Quality Improvement Evaluation System (QIES) Assessment Submission and Processing (ASAP) system and submitted in a timely manner. Specifically, the admission MDS for Resident #1 was not and transmitted within 14 calendar days from MDS completion date. This was evident for 1 of 1 resident reviewed for the Resident Assessment task out a total sample of 27 residents (Resident #1). The finding is: Resident #1 was admitted to the facility on [DATE]. The Minimum Data Set 3.0 (MDS) assessment with an Assessment Reference Date (ARD) date of 6/17/19 had a Care Area Assessment (CAA) completion date of 6/21/19. The MDS was submitted on 7/13/19 which was (8) eight days late. On 11/06/19 at approximately 10:07 AM an interview with the MDS Coordinator, a Registered Nurse, was conducted. He stated that he started approximately one week ago, and the MDS…
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.
“Cited before” means this same F-tag appears on at least one other survey date in the record we hold — counting complaint investigations as well as standard surveys, with no time limit. It is our own read of the data, not CMS’s: CMS uses repeat deficiency as a formal term tied to consecutive standard surveys, and that is a narrower test than this one. A tag marked here may or may not meet it.
- Long-Term Care Ombudsman — a free, confidential advocate for the resident. They act only with the resident’s consent and work to resolve the problem. Find yours at theconsumervoice.org/get_help.
- Adult Protective Services — the state agency that investigates suspected abuse, neglect, or exploitation of a vulnerable adult. Not sure of your state’s APS number? The federal Eldercare Locator will route you: 1-800-677-1116 or eldercare.acl.gov.
- State survey agency — the regulator that licenses and inspects the home. Every state has an official nursing-home complaint line and most take complaints online; the Ombudsman or Eldercare Locator can connect you.
Fines & penalties
No federal fines in the current CMS record.
Who owns this facility
| Owner / manager | Type | Role | Share | Since |
|---|---|---|---|---|
| ISAAC E GOLDBRENNER ESTATE | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST; ADP OF THE SNF | 33% | since 02/19/2024 |
| BRACHFELD, JOSEPH | Individual | 5% OR GREATER DIRECT OWNERSHIP INTEREST; MANAGING CONTROL - GOVERNING BODY; ADP OF THE SNF | 33% | since 03/14/2000 |
| HARTMAN, ISRAEL | Individual | 5% OR GREATER DIRECT OWNERSHIP INTEREST; MANAGING CONTROL - GOVERNING BODY; ADP OF THE SNF | 33% | since 03/14/2000 |
| FELDMAN, BENJAMIN | Individual | CORPORATE DIRECTOR; OPERATIONAL/MANAGERIAL CONTROL | — | since 05/01/2006 |
| CHINTALURI, VENKATA HARINI | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | — | since 04/08/2025 |
| WILLIAMS, CARLTON | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | — | since 03/17/2025 |
| B&G REALTY ASSOCIATES LLC | Organization | ADP OF THE SNF | — | since 03/04/1983 |
| MEDCO ENTERPRISES, INC. | Organization | ADP OF THE SNF | — | since 04/08/2025 |
CMS files one row per role, so the 16 rows in the source record cover these 8 parties — each is shown once here with every role it holds. Nothing is omitted.
3 organizational owners listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.
Follow the money — this home’s finances
Where a nursing home’s revenue comes from and where it goes — including money paid to companies under the same ownership. Most consumer sites never show this; we reproduce it straight from the Medicare cost report.
Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2023. Facilities self-file these reports; figures are unaudited and a year or two behind. A home with no Medicare cost report on file shows no figures here.
Cost & finances
Straight from this home’s Medicare cost report (CMS, FY2023). These are its operating economics — what it costs to run per resident-day and what it collects on average across Medicare, Medicaid, and private pay — not a private-pay quote. Your out-of-pocket cost depends on payer and room type, so ask the facility directly; a higher operating cost can reflect richer staffing or a sicker population. The cost-of-care planner shows regional benchmarks by care type.
What families pay in NY
This is a Medicare- and Medicaid-certified nursing home, so it can accept Medicaid for long-term care — like nearly all U.S. nursing homes. The private-pay figures below are what families without Medicaid pay; once a resident qualifies for Medicaid, out-of-pocket cost for covered nursing-home care is typically close to $0 (almost all of their income goes to the home as their share of the cost; they keep a small personal needs allowance — for clothing, haircuts, a phone — and Medicaid pays the rest). The amount of that allowance is set by each state. Confirm Medicaid-bed availability with the home, and see the New York Medicaid page.
Median private-pay cost, CareScout (Genworth) 2025 Cost of Care Survey — a regional midpoint, not any single community’s rate. Private rooms and higher care levels cost more; ask for a current quote. Project your own in the cost-of-care planner.
Every figure above is reproduced from the CMS Provider Data Catalog (a public record), from the CMS extract processed 2026-08-01 — CMS provider number 335030. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2024-08-16, which can lag current conditions. Staffing hours are CMS PBJ CY2026Q1 (Jan–Mar 2026). Check this record against the government’s own page for it: this home on Medicare Care Compare ↗ — the authoritative source, and the place to confirm anything here before you act on it. How we present it →
Not a government site. Eldercare Lens is not affiliated with, endorsed by, or authorized by the Centers for Medicare & Medicaid Services (CMS), Medicare, or any government agency. The star ratings, citations, and inspection wording on this page are reproduced from the public CMS record; the plain-English summaries, tiers, and comparisons around them are ours. We do not speak for CMS, and CMS has not reviewed this page. For the official record, go to Medicare Care Compare. How we’re funded →
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