Humboldt House Rehabilitation and Nursing Center

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review during the Standard survey completed on 09/16/2025, the facility did not maintain an effective pest control program for four (4) (first, second, third, and fourth floors) of four (4) resident use floors. Issues included observations of evidence of rodents (dead rodents and rodent droppings) and flies.The findings are:The policy and procedure titled Pest Control, revised 7/2023, documented the facility maintains an on-going pest control program to ensure that the building is kept free of insects and rodents. Pest control services are provided by an outside contracted pest control vendor. 1a. Observation on the first floor on 09/09/2025 at 1:40 PM and 09/16/2025 at 1:10 PM revealed rodent droppings were on the floor behind the door of the Dietary Storage Room. During an interview on 09/16/2025 at 1:10 PM, the Dietary Director stated on 09/08/2025, they personally moved chemicals, crates, and carboard in the area behind the door of the Dietary Storage Room. They…

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 during a Complaint investigation (NY00370611-574668, NY00372414-574672, and 2563935) completed during the Standard survey on 09/16/2025, the facility did not provide housekeeping and maintenance services necessary to maintain a safe, clean, comfortable, and homelike environment. Specifically, there were areas of damaged walls and ceilings, dust laden fans inside resident rooms, soiled and sticky floors, and unpleasant odors. This affected three (3) (second, third, and fourth floors) of four (4) resident use floors.The findings are:The policy and procedure titled Homelike Environment, revised February 2021, documented residents are provided with a safe, clean, comfortable and homelike environment. The facility staff and management maximizes, to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting, including a clean, sanitary, and orderly environment and pleasant, neutral scents.The policy and procedure titled…

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, observation, and record review conducted during a Standard survey completed on 9/16/2025, it was determined that the facility did not ensure that the resident has a right to make choices about aspects of his or her life in the facility that are significant to the resident. Specifically, one of three residents (Resident #5) reviewed for choices had issues with not receiving a shower for three weeks per their preference. The finding is:The policy and procedure titled Resident Rights dated 12/2016 documented that the resident has a right to self-determination.The policy and procedure titled Resident Rights Guideline for All Nursing Procedures dated 10/2010 documented that the resident has a freedom of choice.Resident #5 was admitted to the facility with diagnoses of paralysis of the right side of the body and depression. Review of the Minimum Data Set (a resident assessment tool) dated 6/19/2025 documented that the resident understands and is understood by others, cognitively intact, and requires maximal assist of staff for bathing.Review of the comprehensive care…

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 during the Standard survey completed on 09/16/2025, the facility did not implement written policies and procedures for screening employees that would prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property. Specifically, the facility did not provide documentation that verified three (3) (Registered Nurse Supervisor #1, Unit Clerk #1, and Dietary Supervisor #1) of eight (8) employees reviewed that worked in the facility and were subject to the New York State Nurse Aide Registry had been screened through the New York State Nurse Aide Registry prior to their first date worked at the facility.The findings are:The policy and procedure titled Abuse, Neglect, Exploitation and Misappropriation Prevention Program, revised April 2021, documented the resident abuse, neglect and exploitation prevention program consisted of a facility-wide commitment and resource allocation to support its objectives. The objectives included developing and implementing policies and protocols to prevent and identify abuse,…

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 conducted during a Standard survey completed on 9/16/2025, the facility did not ensure that comprehensive care plans included to the extent practicable, the participation of the resident and the resident's representative(s); an explanation must be included in a resident's medical record if the participation of the resident and their resident representative is determined not practicable for the development of the resident's care plan; and were reviewed and revised by the interdisciplinary team after each assessment, including both the comprehensive and quarterly review assessments for two (2) (Residents #29 and #74) of two (2) residents reviewed for care plan participation and care plan revision related to accidents. Specifically, Resident #74's representative was not invited to participate in care plan meetings and Resident #29's care plan was not revised when the resident was removed from one to one supervision after they transferred to a secure unit. The findings are:The undated document titled Social Worker documented that a Social Worker…

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 conducted during the Standard survey completed on 9/16/25, the facility did not ensure that each resident received treatment and care in accordance with professional standards of practice for one (1) (Resident #88) of one (1) resident reviewed for positioning. Specifically, while sitting in their wheelchair, Resident #88's feet were hanging down and were approximately four (4) to six (6) inches from touching the floor for extended periods of time.Based on observation, interview, and record review conducted during the Standard survey completed on 9/16/25, the facility did not ensure that each resident received treatment and care in accordance with professional standards of practice for one (1) (Resident #88) of one (1) resident reviewed for positioning. Specifically, while sitting in their wheelchair, Resident #88's feet were hanging down and were approximately four (4) to six (6) inches from touching the floor for extended periods of time. The finding is: The policy and procedure titled Repositioning revised May 2013 documented…

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 conducted during the Standard survey, completed on 09/16/2025, it was determined that the facility did not ensure that residents received proper treatment and assistive devices to maintain vision abilities; and if necessary, must assist the resident in making appointments for one (1) (Resident #57) of one (1) resident reviewed for treatment/services to maintain vision. Specifically, the facility did not act on the optometry recommendations for cataract surgery for Resident #57 from 10/29/2024 and again on 06/10/2025. The finding is:The policy titled Resident Rights, last revised December 2016, documented federal and state laws guaranteed certain basic rights to all residents of the facility. Those rights included the residents right to a dignified existence and communication with and access to people and services, both inside and outside the facility.The facility did not have any policies regarding hearing or vision, consultants or outside consults, or provider recommendations.Resident #57 had diagnoses including schizoaffective disorder (a…

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 conducted during a Complaint investigation (Complaint #NY00381662-574015) during the Standard survey on 09/16/2025, the facility did not ensure the resident's environment remained free from accident hazards over which the facility had control and provide adequate supervision to prevent accidents for one (1) (Resident #29) of one (1) resident reviewed for elopement. Specifically, on 05/26/2025 Resident #29 had exited the facility through a service door, out of a fenced gate and was found at the local corner store. Additionally, Resident #29 was observed not wearing their wander guard as care planned, wander guard checks were not implemented for placement every shift, and the 11:00 PM-7:00 AM wander guard checks for functionality were not implemented. The finding is:The policy and procedure titled Wandering and Elopements, last revised March 2019, documented the facility will identify residents who are at risk of unsafe wandering and strive to prevent harm while maintaining the least restrictive environment for residents. The policy…

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, interviews and record review conducted during an Extended survey completed on 10/10/2025, the facility did not ensure that each resident received the necessary behavioral health care and services to attain or maintain the highest practicable mental and psychosocial well-being for two (2) (Residents #6 and #155) of five (5) residents reviewed. Specifically, Resident #6 was not receiving psychotherapy services and/or group therapy services as recommended by their psychiatry provider and there was a delay in obtaining a follow up psychiatry consult as recommended for Resident #155. The findings are:The undated policy titled Resident Rights documented federal and state laws guarantee certain basic rights to all residents of the facility. The policy documented those rights included the resident right to self-determination; be informed of, and participate in, his/her care planning and treatment; and participate in decision-making regarding his/her care. 1.Resident #6 had diagnoses that included…

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 conducted during a Complaint Investigation (Complaint #NY00379533) the facility did not maintain an effective pest control program so that the facility was free of rodents for three (first, third, and fourth floors) of four resident use floors. Specifically, there were multiple observations of dead rodents in traps, evidence of rodent droppings, and complaints of rodent sightings in resident rooms. The findings are: 1a. Observations on the third floor on 6/18/25 between 8:54 AM and 10:00 AM revealed the following: -Five rodent droppings observed inside Resident room [ROOM NUMBER] in the far-right corner of the room, to the side of the large wardrobe. -In Resident room [ROOM NUMBER], the three-drawer dresser in center of room had ten to twelve rodent droppings inside the drawers. There was a cookie wrapper inside a drawer with several droppings in the wrapper. Also, about twelve rodent droppings were observed on the floor in this room's closet in the far corner,…

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, record review and interviews during a complaint investigation (#NY00356620) the facility did not ensure that all residents receive treatment and care in accordance with professional standards of practice for the comprehensive care plans for one (1) (Resident #2) of three (3) residents reviewed. Specifically, treatments to the resident's bilateral lower extremity venous (relating to the vein) ulcers were not being completed as ordered by the physician. The finding is: The policy and procedure titled Pressure Ulcers/ Skin Breakdown- Clinical Protocol with a revision date of March 2014 documented the physician will authorize pertinent orders related to wound treatments, including wound cleansing and debridement approaches, dressings, and application of topical agents if indicated for type of skin alteration. The policy and procedure titled Medication and Treatment Orders with a revision date July 2016 documented orders for medications and treatments will be consistent with principles of safe and effective order writing. Medications shall be administered only upon…

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 conducted during an Abbreviated survey completed on 12/31/24 (Complaint # NY00357248) the facility did not protect residents from sexual abuse for two (Resident #1 and #2) of three residents reviewed for abuse. Specifically, Resident #1 wandered into Resident #2's room without staff knowledge and they were found engaged in sexual activity. Resident #1 and Resident #2 both lacked the ability to consent due to their cognitive impairment. The finding is: The policy titled Abuse, Neglect, Exploitation and Misappropriation Prevention Program, revised September 2021, documented residents have the right to be free from abuse by anyone which includes but is not limited to verbal, mental, sexual, and physical abuse. Establish and maintain a culture of compassion and caring for all residents and particularly those with behavior, cognitive and emotional problems. The policy titled Identifying Sexual Abuse and Capacity to Consent, dated September 2022, documented a…

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 interview and record review conducted during a Complaint (#NY00363866) investigation, the facility did not ensure that residents receive treatment and care in accordance with professional standards of practice for one (Resident #1) of three residents reviewed for quality of care. Specifically, there was no skin assessment completed for a resident readmitted to the facility with multiple pressure and vascular ulcers (develop due to poor circulation) that included measurements, description of the ulcers, and staging (pressure); this resulted in a delay in obtaining physician orders and treatment initiation. The finding is: The undated policy titled Pressure Ulcers/Skin Breakdown - Clinical Protocol documented the staff will examine the skin of a new admission for ulcerations or alterations in skin. The nurse shall describe and document/report the following: full assessment of pressure sore including location, stage, length, width and depth, presence of exudates (drainage) or necrotic (dead) tissue. 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation and interview and record review during a compliant investigation (#NY003266278, #NY00332285) completed during an extended survey ending 5/23/24, the facility did not provide housekeeping and maintenance services necessary to maintain a safe, clean, comfortable, and homelike environment. Specifically, four (1st, 2nd, 3rd, 4th) of four floors had environmental concerns. The issues involved the lacked hot water in resident rooms; lack of adequate resident access to bathrooms, plastic bags over sinks, and call bells that were not functioning in a shared resident bathroom. Additionally, observed were soiled walls, dirty window shades, dirty utility hoppers, mold in shower rooms, foul odors, windows, and ceilings in disrepair/stained. The findings are: The policy statement titled Water Temperatures, Safety of revised 12/09, documented tap water in the facility shall be kept within temperature range to prevent scalding residents. Water heaters should be set no more than 110 degrees. The 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.

Based on observation, interview, and record review conducted during the Extended Recertification and Complaint (#NY00333644) survey completed on 5/23/24, the facility did not provide food and drink that was at a safe and appetizing temperature for three (Second floor Unit, Third floor Unit, and Fourth floor Unit) of three test trays. Specifically, food and beverages during meals were served at suboptimal temperatures and were not palatable. Residents #21, #27, #41, #82, #125, #134, #359, and #506, were involved. The findings are: The policy and procedure titled Food Temperature Monitoring dated 3/23/23, documented that potentially hazardous foods shall be kept at 41 degrees Fahrenheit or below when cold or 135 degrees Fahrenheit or above when hot, and temperatures shall be maintained during storage, preparation, transport, and service. During an interview 5/13/24 11:54 AM, Resident #134 stated the food that was provided to the residents was horrible, portion sizes were very small, the biscuits were hard, the bread was soggy, and they had found hair in their food once. They stated…

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 conducted during an Extended survey completed on 5/23/24, the facility did not store food in accordance with professional standards for food safety for three (Second floor Unit, Third floor Unit, and Fourth floor Unit) of three nourishment unit refrigerators reviewed. Specifically, the nourishment kitchen refrigerators contained undated, unlabeled, expired food and drink items, and had liquid spills and dried substances on surfaces; the Fourth floor Unit refrigerator was not holding a safe food storage temperature and subsequently lacked a thermometer; the Second floor Unit refrigerator had no thermometer. The findings are: The policy and procedure titled Food Temperature Monitoring dated 3/23/23, documented that the temperature of each refrigeration unit used for food and beverage storage shall be monitored twice a day at the start of first shift and just prior to closing the area for the day. The policy and procedure titled Foods brought by Family/Visitors from the Nursing Services Policy and Procedure Manual for Long-Term Care…

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 conducted during an Extended survey completed on 5/23/24, the facility did not ensure that each resident had the right to participate in the development and implementation of their person-centered care plan and facilitate the inclusion of the resident for one (Resident #134) of four residents reviewed. Specifically, Resident #134 was not informed, in advance to participate in their scheduled care plan meeting. The finding is: The policy and procedure titled Resident Participation - Assessment/ Care Plans dated February 2021, documented the resident has the right to participate in the development and implementation of their plan of care. The facility staff supports and encourages resident to participate in the care planning process by providing sufficient notice in advance of the meeting; and planning for enough time for exchange of information and decision making. The Social Services Director or designee was responsible for notifying the resident and for maintaining records of such notices. Resident #134 had diagnoses that included benign…

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 conducted during an Extended Recertification and Compliant (#NY00332285, #NY00329276) survey completed on 5/23/24, the facility did not ensure that each residents had the right to be treated with respect and dignity for three (Resident #1, #101 and #134) of six residents. Specifically, a resident was treated disrespectfully and without dignity when a staff member acted in an unprofessional and undignified manner (#134). In addition, a multi stall bathroom was shared by both male and female residents on the dementia unit without privacy door and/or curtains (#1 and #101). The findings are: The policy and procedure titled Dignity dated 2/21 documented each resident shall be cared for in a manner that promotes their sense of well-being, and feelings of self-esteem. The residents are always to be treated with dignity and respect. 1. Resident #134 had diagnoses that included benign intracranial hypertension (increased pressure in the skull), chronic pain syndrome, and migraine headaches. The Minimum Data Set (a resident assessment tool)…

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 interview and record review conducted during an Extended Recertification and Complaint (#NY00339732) survey completed 5/23/24 the facility did not ensure that all alleged allegations of abuse, were thoroughly investigated for two (Resident #74 and #129) of fourteen residents reviewed. Specifically, there was a delay in the initiation of an investigation for a reported allegation of resident- to- resident abuse. Additionally, the facility did not complete a thorough investigation to include interviews of residents involved and other potential witnesses. The finding is: The policy and procedure titled Abuse, Neglect, Exploitation and Misappropriation-Reporting and Investigating revised September 2022 documented all reports of resident abuse are thoroughly investigated by facility management. The individual conducting the investigation as a minimum: observes the alleged victim, including their interactions with staff and other residents; interviews the resident (as medically appropriate) or the resident'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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review conducted during the Recertification Survey and Complaint (#NY00326278) survey completed on 5/23/24, the facility did not ensure that each resident who was unable to carry out Activities of Daily Living received the necessary services to maintain grooming and personal hygiene for three (Resident #27,102, 105) of six residents reviewed for Activities of Daily Living. Specifically, Resident #27 was not provided with timely incontinence care that resulted in their brief and bed linens saturated with urine through to the mattress, also the Certified Nurse Aide performed incomplete incontinence care (lack of washing bilateral buttocks and hips and removal of saturated brief) with improper hand hygiene, glove changes, and touched items in the resident's room with soiled gloves. Additionally, Residents #102 and #105 had long jagged fingernails with brown debris. The findings are: Review of the policy and procedure titled Perineal (the area between the anus 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review conducted during an Extended Survey completed on 5/23/24, the facility did not ensure that each resident received treatment and care in accordance with professional standards of practice and the comprehensive person-centered care plan, for four (Resident #16, #154, #305, #360) of thirty three residents reviewed for quality of care. Specifically, the issues involved inaccurately transcribed physician's orders resulting in delay in treatment and there was no comprehensive care plan developed for indwelling foley catheter use and urinary tract infections (#16). In addition, PICC (peripheral inserted central catheter) line dressing changes (#305, #360), and supplements were not administered in accordance with physician's orders (#154). The findings are but not limited to: The policy and procedure titled Medication and Treatment Orders revised date July 2016 documented that verbal orders must be recorded immediately in the resident's chart by the person receiving 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review conducted during the Extended Survey completed on 5/23/24, the facility did not ensure each resident was offered the pneumococcal and influenza immunizations. Additionally, the facility did not ensure the residents medical record includes documentation that indicates education regarding the benefits and the potential side effects of the immunizations was provided for four (Resident #10, #54, #406, #456) of five residents reviewed. Specifically, there was no documented evidence that residents #10, #54, #406, and #456 were offered/declined, and educated on the influenza, pneumococcal immunizations. The findings are but not limited to: The policy and procedure titled Pneumococcal Vaccine dated 10/23 documented all residents are offered pneumococcal vaccines to aid in preventing pneumonia/pneumococcal infections. The policy documented that assessments of pneumococcal vaccination status are conducted within five business days of admission to the facility. Education of benefits,…

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 interview and record review conducted during a complaint investigation (#NY00328621) completed 1/25/2024, the facility did not ensure that all alleged allegations of abuse, were thoroughly investigated for one (Resident #1) of three residents reviewed. Specifically, the facility did not complete a thorough investigation into an injury of unknown origin, a bruise to Resident #1 face to include staff interviews. The finding is: Review of the policy and procedure titled Abuse, Neglect, Exploitation or Misappropriation - Reporting and Investigating revised in 9/2022 documented all reports of resident abuse (including injuries of unknown origin) neglect, exploitation, or theft/ misappropriation of resident property are reported to local, state, and federal agencies (as required by current regulations) and thoroughly investigated by facility management. Findings of all investigations are documented and reported. The individual conducting the investigation at a minimum will interview the person reporting 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and interview conducted during an Abbreviated survey (Complaint #NY00301582) completed 9/18/23, the facility did not provide a homelike environment, allowing residents to use their personal belongings to the extent possible and exercise reasonable care for protection of the resident's property from loss for one (Resident #2) of three residents reviewed. Specifically, Resident #2 was observed wearing the same clothes for three days and had no other clothing available that belonged to them. Additionally, the clothes that were in Resident #2 closet belonged to the previous resident. The finding is: The facility's policy revised August 2022 and titled, Personal Property documented residents are permitted to retain and use personal possessions, including furniture and clothing, as space permits, unless doing so would infringe on the rights or health and safety of other residents. Residents are encouraged to use personal belongings to maintain a homelike environment and foster…

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 conducted during a Complaint Investigation (Complaint #NY00304843) completed during the Standard survey completed 2/9/23, the facility did not maintain an effective pest control program so that the facility is free of rodents. One of one kitchen and three (Unit 2, 3 & 4) three units had issues with rodents. There were multiple observations of evidence of mice (droppings) and traps. In addition, multiple complaints of mouse siting's in resident rooms, hallways, kitchen, and food storage areas. This involved Residents #59, 67, 93, 104, 138, 139, and 452. The findings are: The policy and procedure (P/P) titled Pest Control dated 5/08 documented the facility shall maintain an effective pest control program. This facility maintains an on-going pest control program to ensure that the building is kept free of insects and rodents. The P/P titled Preventing Foodborne Illness-Food Handling dated 7/14 documented food will be stored, prepared, handled and served so that 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review conducted during the Standard survey completed 2/9/23, the facility did not protect, promote, and treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. Specifically, there was a lack of dignity with dinning. Two (Resident #138 and #450) of two residents reviewed had issues with a delay in assistance with eating, standing while feeding (#450) and not receiving preferences (#138). Additionally, three (Units 2, 3 and 4) of three resident units had issues with the use of plastic utensils or no utensils, no glasses or straws provided for beverages in cartons, no condiments, and coffee was not served on the lunch and dinner trays. This involved Residents # 83,138, 451, and 452. The findings are: The policy and procedure (P/P) titled Dignity dated 2/21 documented each resident shall be cared for in a…

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, record review, and interview conducted during a Standard survey completed 2/9/23, the facility did not provide food and drink that was palatable, attractive, and at a safe and appetizing temperature. Specifically, three (Units #2, #3 and #4) of three resident units reviewed for food temperatures during meals had issues involving trays being passed on the units with long wait times, food items that were not palatable and not served at safe and appetizing temperatures. Residents' #58, #83, #104, #138, #452 and #453 were involved. The findings are: The facility's policy and procedure (P&P) titled Food Preparation and Service dated/revised 4/2019 documented food and nutritional service employees shall prepare and serve food in the manner that complies with safe food handling. The danger zone for food temperatures is between 41 degrees Fahrenheit (°F) and 135 °F. The longer foods remain in the danger zone the greater the risk for growth of harmful pathogens. Therefore, potentially hazardous foods must be maintained at 41 °F or below or at 135 °F or above. 1.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.

Based on observation, interview, and record review conducted during a Complaint Investigation (Complaint #NY00304843) completed during the Standard survey completed 2/9/23, the facility did not store, prepare, distribute, and serve food in accordance with professional standards for food service safety. Specifically, one of one Kitchen had floors that were sticky, not swept and had a thick black substance buildup along the walls of the perimeter of the kitchen and in the grout between the tiles. Wire shelves and equipment had a thick layer of sticky grease buildup. There were multiple tiles missing on the walls and floor throughout the kitchen. Threshold to a door entering the kitchen had a one foot by one foot hole in the concrete. Ceiling was leaking near the air conditioning unit with a liquid substance dripping onto the floor. Ceiling throughout the kitchen had a dark thick black dust like substance, was also on the pipes on the ceiling and sprinkler heads, all of which was above the area of tray line service. The ice machine had rusted bolts inside which where touching the ice…

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 during the Standard survey completed on 2/9/23, the facility did not operate and provide services in compliance with all applicable Federal, State, and local laws, regulations, and codes. Specifically, the facility was not in compliance with Section 915 of the 2020 Fire Code of New York State, which requires carbon monoxide (CO) detection shall be installed in residential buildings and commercial buildings in all rooms and occupiable spaces, that contain a fuel burning appliance and the facility did not have a policy and procedure for the installation, inspection, testing, and maintenance of carbon monoxide (CO) detectors. This affected one (First floor) of four resident use floors. The findings are: According to the 2020 Fire Code of New York State, carbon monoxide (CO) detection shall be installed in residential buildings and commercial buildings in all rooms, occupiable space, dwelling units, sleeping areas, and sleeping units that contain a fuel burning…

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 conducted during a Complaint Investigation (Complaint #NY00307276) completed during the Standard survey completed on 2/9/23, the facility did not exercise reasonable care for the protection of the resident's property from loss or theft and maintain a sanitary, orderly, and comfortable interior. Specifically, one (Resident #452) of four residents reviewed for personal property was transferred to the hospital on 1/23/23 and returned to the facility on 1/31/23 and has not been given their personal property back that was left at the facility during hospitalization. In addition, two (Units #2 and #3) of three units had issues with dirty linen, dirty floors, dirty tub rooms to include but not limited to dirty grout, peeling paint and soiled linen and paper debris all over the floor. This involved Residents #101 and #138. The findings are: The policy and procedure (P/P) titled Personal Property revised 3/21 documented residents are permitted to retain and use personal…

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 conducted during a Complaint Investigation (Complaint #NY00291178 and NY00298606) completed during a Standard survey completed 2/9/23, the facility did not ensure the resident environment was free of accident hazards and adequate supervision was provided for two (Resident's #28 and #94) of four residents reviewed for accidents. Specifically, staff reheated coffee in a microwave, did not take the temperature of the beverage before they served it, and the resident sustained a burn (Resident #28); the facility did not have an effective system in place for monitoring the wander guard (device to detect wandering) functionality and presence of bracelets, and the care plan did not include use of a wander guard (Resident #94). The findings are: The facility policy and procedure (P&P) titled Accidents and Incidents-Investigating and Reporting revised July 2017 documented incident/accident reports will be reviewed by the Safety Committee for trends related to accident or…

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 conducted during the Standard survey completed on 2/9/23, the facility did not maintain resident call bell systems in working order. Specifically, call bells in resident rooms did not activate the light above the room's door or the indicator of the call bell system at the Nurses' Station. This affected two (third floor and fourth floor) of three resident floors. This involved Residents # 35,38, 58, 298 and 398. The findings are: The facility's policy and procedure titled Call Light/Call Bell/Nurse Call System dated 9/6/18 documented residents will be provided access to a call light. The call light would be answered promptly. A visual light would be present outside of each room. In some cases, an audible signal would be present with the activation of the call system. If a call bell was defective, report immediately to the immediate supervisor. a. During observations and interviews on the third floor on 2/2/23 from 9:39 AM to 3:30 PM revealed the following: - 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.