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Susquehanna Nursing & Rehabilitation Center, L L C

282 Riverside Dr, Johnson City, NY 13790 · For profit - Limited Liability company · 160 certified beds · (607) 729-9206 Medicare & Medicaid certified

Call the home — (607) 729-9206 Need help choosing, fast? Free, unbiased: Eldercare Locator 1-800-677-1116
Abuse-prevention, restraint, or reporting citation — no harm found (F0610) — cited Aug 20221 actual-harm citation$32,321 in federal fines
Insights

The public record raises real questions here. Weigh the concerns below carefully.

Worth asking about
  • it has a citation for its abuse-prevention policies, restraint use, or reporting and investigating of allegations (F0610) — cited below the harm level, meaning inspectors found the process wanting but did not find a resident harmed
  • it has 1 actual-harm citation
  • a high number of inspection citations overall (31) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
  • the CMS record shows $32,321 in federal fines (most recent 2024-09-16)
  • its facility-reported quality-measure score sits well above its independent inspection score
  • its independent health-inspection rating is low (1/5)
  • its payroll-based staffing rating is low (2/5)
  • nursing-staff turnover (57%) runs well above the national median (45%)
  • 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.

1/5
CMS overall
1 of 5
Health inspectionSurveyor-assigned, ranked within your stateInspector-verified 1 of 5
StaffingFrom payroll records (PBJ) 2 of 5
Quality measuresSelf-reported by the facility 3 of 5

Worth a closer look. This home's quality-measure rating runs 2 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

Hospital
★★★ 3/5 CMS · Emergency dept. usually open 24/7 · ER 24/7
Urgent care / clinic
240 Riverside Dr · (607) 798-9356 · Call to confirm hours
Pharmacy
37 Riverside Dr · (607) 729-1588 · Call to confirm hours
Grocery
24 Bernice St · (718) 844-9756 · Call to confirm hours
Park
200 Floral Ave · (607) 797-3031 · Typically dawn to dusk
Place of worship
325 Burbank Ave · (607) 729-4138

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 3 of 5
Long-stay residentspeople who live here 4 of 5
Short-stay residentsrehab / post-hospital 3 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 held steady at 1 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.

Overall rating1★
Inspection scorelower = better
See all quality measures vs. state & national benchmarks
MeasureThis homeState avgTypical statevs typical state
Long-stay residents whose need for help with daily activities increased12.2%14.1%15.4%better
Long-stay residents who lose too much weight9.6%5.8%5.4%worse
Long-stay residents with a catheter left in their bladder1.0%0.5%0.9%typical
Long-stay residents with a urinary tract infection1.1%1.3%2.0%better
Long-stay residents with depressive symptoms2.7%19.5%6.5%better than state — see note marked double-dagger below the table
Long-stay residents who were physically restrained0.0%0.2%0.1%better
Long-stay residents with falls causing major injury2.0%3.1%3.3%better
Long-stay residents whose ability to walk worsened8.5%12.5%16.1%better
Long-stay residents on antianxiety or hypnotic medication15.5%13.2%18.9%better
Long-stay residents given the seasonal flu vaccine63.2%95.3%95.3%worse
Long-stay residents with pressure ulcers6.1%6.5%4.7%worse
Long-stay residents with worsening bladder/bowel control8.0%19.5%21.2%better
Long-stay residents who got an antipsychotic medication — see the note below the table22.2%13.7%17.1%worse
Short-stay residents who newly got an antipsychotic medication1.1%1.2%1.4%better
Short-stay residents given the seasonal flu vaccine69.5%78.8%79.4%worse
Short-stay residents rehospitalized after admission21.1%20.6%22.6%typical
Short-stay residents with an outpatient ER visit10.1%9.6%12.0%better
Long-stay hospitalizations per 1,000 resident days2.361.701.67worse
Long-stay outpatient ER visits per 1,000 resident days1.241.361.80better

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.

51.3% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — which CMS reads as no different from the national rate. This is CMS’s risk-adjusted rate over 166 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

51.3%U.S. median 51.5%
Got home and stayed home
9.9%U.S. median 10.7%
Went back to hospital
51.2%U.S. median 56.6%
Met the expected recovery
0.27U.S. median 0.31
Therapy hours / resident / day
0.13hours / resident / day
Physical therapy
0.11hours / resident / day
Occupational therapy
0.03hours / resident / day
Speech therapy

Met the expected recovery: 51.2% 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 82 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 39% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 3% of this home’s weekday level — it runs therapy on weekdays, with essentially none at the weekend. 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
MeasureThis homeU.S. medianPeriod coveredCMS’s call
Got home and stayed homeRate of successful return to home or community from a SNF51.3%CMS range 44.0–58.851.5%Oct 2022–Sep 2024no different from U.S.
Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF9.9%CMS range 6.3–12.910.7%Oct 2022–Sep 2024no 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 discharge51.2%56.6%Oct 2024–Sep 2025CMS 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 discharge31.7%52.8%Oct 2024–Sep 2025CMS makes no comparison for this measure
Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge53.7%50.0%Oct 2024–Sep 2025CMS 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 identified99.0%98.7%Oct 2024–Sep 2025CMS 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 settingnot reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality 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 discharge97.4%98.7%Oct 2024–Sep 2025CMS makes no comparison for this measure
Falls with major injuryPercentage of SNF residents who experience one or more falls with major injury during their SNF stay0.0%0.0%Oct 2024–Sep 2025CMS makes no comparison for this measure
New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsened1.0%1.9%Oct 2024–Sep 2025CMS makes no comparison for this measure
Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalization7.3%CMS range 3.9–11.47.1%Oct 2023–Sep 2024no different from U.S.
Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs0.791.02Oct 2022–Sep 2024CMS 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

0.39
RN hours/ resident / day
0.85
LPN hours/ resident / day
1.76
Aide hours/ resident / day
2.99
Total nurse hours/ resident / day
0.17
RN hoursweekends
56.8%
Total nursing turnover
40.0%
RN turnover

How full it usually is: this home is certified for 160 beds and averages 147.9 residents a day — about 92% occupied, or roughly 12 beds typically open. It runs fairly full. 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 2.99 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.39 is below the 0.55-hour RN benchmark and nurse-aide staffing of 1.76 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 2.58 hrs/resident/day on weekends vs 3.16 on weekdays — 19% thinner on weekends. RN hours go from 0.48 to 0.17 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 57% is well above the national median of 45%.

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

13
deficiencies at the latest standard inspection (2024-09-16)
8
at the previous standard inspection (2022-08-02)

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.

ABCDEFGHIJKL

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.

31 citations, most serious first. The 11 most serious are shown; the remaining 20 are one tap away and print in full.

  • Actual harm · G2024-09-16 · tag F0686 — failed to prevent and treat pressure sores (bedsores) — isolated
    Provide appropriate pressure ulcer care and prevent new ulcers from developing.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on record review and interviews during the recertification and abbreviated (NY00350839) surveys conducted 9/9/2024-9/16/2024, the facility failed to ensure a resident with pressure ulcers received the necessary treatment and services, consistent with professional standards of practice, to promote wound healing, prevent infection and prevent new ulcers from developing for 2 of 6 residents (Residents #88 and #195) reviewed. Specifically, Resident #88's wound treatments were not consistently documented as completed; and Resident #195 developed impaired skin integrity on the sacrum (the triangular bone at the base of the spine) that was not assessed by a qualified professional to determine interventions and routine monitoring, and treatments were not consistently applied as ordered. Subsequently, the area progressed to a Stage 4 (full thickness skin loss exposing muscle, bone, or tendon) pressure ulcer and the resident developed sepsis requiring hospitalization. This resulted in actual harm to Resident #195 that was not immediate jeopardy. Findings include: The facility 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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Fcited before2026-02-27 · tag F0921 — failed to keep a safe, functional, sanitary building — widespread
    Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
    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, observation, and interview the facility failed to ensure a safe, clean, comfortable, and homelike environment for one (1) resident unit. Specifically, the temperature of the facility's hot water was not maintained.Findings include:An undated resident bathing training form documented:- if the resident refused to take a shower or bath because the water was too cold, the supervisor was required to be notified immediately; and- anytime a supervisor was notified of cooler than normal water temperatures the Director of Nursing and the Administrator must be notified immediately. An undated creating maintenance requests training form documented how staff can enter work orders. An 09/09/2025 loss of hot water policy documented the following:- Notify the maintenance department of the loss of hot water by either entering a work order, or directly contacting the maintenance department;- Take water temperatures at identified locations of water loss, if the water temperatures were outside of 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.

    Environmental Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2025-03-04 · tag F0684 — failed to provide proper treatment and quality of care — isolated
    Provide 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

    Based on record review and interviews during the abbreviated survey (NY00371419), the facility did not ensure residents received treatment and care in accordance with professional standards of practice, the comprehensive care person-centered care plan, and the resident's choices for 2 of 3 residents (Resident #1 and 7) reviewed. Specifically: -Resident #1 had a feeding tube (a device that delivered liquid nutrition into the stomach or intestine through a surgically created opening in the abdomen) and had physician orders to verify placement and check residuals. There was no documented evidence that placement and residuals were checked for 4 months. The resident developed new onset diarrhea and nausea, and there was no documented evidence the resident was assessed to determine if the resident's tube feeding should have been held. Approximately 8 hours later, the resident was found deceased with vomit on their face. -Resident #7 had an order for lorazepam 0.5 milligrams (a controlled substance medication for anxiety) by mouth every day at bedtime and the resident did not receive 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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2025-03-04 · tag F0835 — failed to run the facility competently — isolated
    Administer the facility in a manner that enables it to use its resources effectively and efficiently.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on record review and interview during the abbreviated survey (NY00371419), the facility was not administered in a manner that enabled it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental and psychosocial well-being for 1 of 3 residents (Resident #2). Specifically, facility Administration, including the Director of Nursing, did not ensure a complete and accurate investigation was completed following an allegtion of abuse. Additionally, the staff statements provided to the Department of Health (as part of the abuse investigation) were falsified. The staff that provided statements stated they did not author the statements or provide a verbal statement to anyone at the facility, they did not sign the statements, and the signatures on the documents were not theirs. Findings include: The facility policy, Facility Incident/Abuse Investigation and Reporting revised 6/7/2023, documented should a resident be observed with unexplained injuries or suspected/alleged abuse, neglect or mistreatment, the employee notified 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.

    Administration Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Ecited before2024-09-16 · tag F0584 — failed to keep a safe, clean, comfortable home — pattern
    Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
    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 during the recertification and abbreviated surveys (NY00314894 and NY99331169) conducted 09/9/2024-9/16/2024, the facility did not provide a safe, clean, comfortable, and homelike environment for 4 of 4 resident areas (Main Lobby, Second floor resident room [ROOM NUMBER]A, Third floor nursing station, and Third floor day room area) reviewed; and for 2 of 2 oxygen storage rooms (Third and Fourth floor oxygen storage rooms) reviewed. Specifically, there were multiple walls with peeling wallpaper and unclean floors with dust and food debris. Additionally, Resident #36's right wheelchair brake was broken and not repaired timely. Findings include: The facility policy, Daily Cleaning, dated 6/1/2000, documented the facility was cleaned daily and would be always kept clean; VCT (vinyl composition tile) flooring was dust mopped and then wet mopped with the specified cleaner; walls and doors were spot washed with a disinfectant cleaner when soiled; and all repair work…

    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.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Ecited before2024-09-16 · tag F0692 — failed to prevent malnutrition and dehydration — pattern
    Provide enough food/fluids to maintain a resident's health.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on record review and interview during the recertification and abbreviated (NY00350839 and NY00331169) surveys conducted 9/9/2024-9/16/2024, the facility did not ensure maintenance of acceptable parameters of nutritional status for 3 of 4 residents (Residents #2, #88, and #195) reviewed. Specifically, Residents #2, #88, and #195 developed pressure ulcers and their nutritional needs were not reassessed timely to accommodate increased requirements for wound healing. Findings include: The facility policy, Nutritional Screen/Assessment, revised 5/2017, documented the dietetic technician and registered dietitian were responsible for nutritional screening, assessment, setting of measurable goals and implementing the nutritional plan of care to obtain the resident's optimal nutritional status. The screening included but was not limited to skin intervention as indicated. The resident would be continually assessed, and findings were documented in the dietary progress notes and nutritional care plan. Estimated needs were documented as 30 - 35 calories/ kilograms of body weight for…

    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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2024-09-16 · tag F0761 — failed to label and store drugs safely — pattern
    Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, record review, and interview during the recertification survey conducted 9/9/2024-9/16/2024, the facility did not ensure drugs and biologicals were labeled and stored in accordance with currently accepted professional principles and include the expiration date when applicable for 3 of 3 medication carts (Second floor short hall, Second floor long hall, and Third floor long hall) reviewed. Specifically, - the Second floor short hall medication cart contained 49 loose, unidentified pills; eye drops for Resident #446 without an opened or expired/discard date; inhalers for Residents #127, #118 and #47 without an opened or expired/discard date; and an inhaler without any resident identifiers. - the third-floor long hall medication cart had one loose pill; 2 opened medicated pain patches and a vial of nitroglycerin (treats chest pain) tablets without resident identifiers; an insulin (treats blood sugar) pen for Resident #14, eye drops for Resident #33, and inhalers for Residents #63, #18, and #16 that did not have opened or expired/discard dates. Findings 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.

    Pharmacy Service Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2024-09-16 · tag F0804 — failed to serve food at safe, palatable temperature — pattern
    Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation and interview during the recertification and abbreviated (NY00336546) surveys conducted 9/9/2024-9/16/2024, the facility did not ensure each resident received food and drink that was palatable, flavorful, and at an appetizing temperature for 1 of 2 meals (the 9/10/2024 dinner meal) reviewed and for 4 of 4 residents (Residents #15, #93, and #112). Specifically, food was not served at palatable and appetizing temperatures during the dinner meal on 9/10/2024. Additionally, Residents #15, #93, and #112 stated the food was served cold, and Resident #36 stated the food was not palatable and was served cold. Findings include: The facility policy, Food Preparation, Service and Distribution, revised 10/2022, documented: - Holding foods in the tray line or alternate meal preparation and service areas may include steam tables, where hot foods were held and served, and chilled areas where cold foods were held and served, would not hold foods in the danger zone (temperatures above 41 degrees Fahrenheit and less than 135 degrees Fahrenheit). - Dining locations included any…

    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.

    Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Ecited before2024-09-16 · tag F0812 — failed to store, cook, and serve food safely — pattern
    Procure 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

    Based on observation, record review, and interviews during the recertification survey conducted 9/9/2024- 9/16/2024, the facility did not ensure food was prepared, distributed, and served in accordance with professional standards for food service in the facility's main kitchen and Third floor kitchenette. Specifically, in the main kitchen, there was debris on the floors and counters, unclean areas, a drain back up, gloves were not used properly, and food was not cooled properly. The Third floor kitchenette was unclean. Findings included: The facility policy, Grease Traps, revised 12/2006, documented the facilities safety elements of the environment were maintained, tested, inspected, and included checking the grease traps monthly. Staff should maintain the sanitation of the kitchen through compliance with a written, comprehensive cleaning schedule. The facility policy, General Kitchen Cleaning, revised 6/1/2023, documented staff shall maintain sanitation of the kitchen through compliance with a written comprehensive cleaning schedule. The facility policy, Food Cooling Temperature…

    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.

    Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2024-09-16 · tag F0550 — failed to protect resident dignity and rights — isolated
    Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview, and record review during the recertification survey conducted 9/9/2024-9/16/2024, the facility did not ensure each resident had the right to a dignified existence for 2 of 6 residents (Residents #37 and #137) reviewed. Specifically, Resident #37 was not provided with a requested shower prior to attending a significant family event, and Resident #137's urinary collection bag was visible in plain sight. Findings include: The facility policy, Activities of Daily Living, revised 10/2023, documented the facility would provide each resident the necessary care and services to attain or maintain their highest practicable physical, mental, and psychosocial well-being consistent with the resident's comprehensive assessment and plan of care. The facility policy, Resident Rights and Responsibilities, revised 4/2/2024, documented the facility functioned on the premise that the service it rendered would demonstrate its belief in the dignity and worth of every individual, and the objective of the facility was to provide the resident with optimal nursing 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.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2024-09-16 · tag F0554 — isolated
    Allow residents to self-administer drugs if determined clinically appropriate.
    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 during the recertification survey conducted [DATE]-[DATE] the facility did not ensure that residents were assessed to determine their ability to safely self-administer medication, when clinically appropriate for 3 of 3 residents (Residents #38, #41, and Resident #95) reviewed. Specifically, Residents #38, #41, and #95 had prescription medications at their bedsides without physician orders for self-medication administration or resident assessments to determine their ability to safely self-administer medications. Additionally, Resident #95 had a discontinued prescription medication at their bedside. Findings include: The facility policy, Inhalers, revised 3/2011, documented licensed nurses would administer inhaler medications as indicated and ordered by the physician. Inhalers were stored (labeled) in the medication cart and discarded when empty or expired. The facility policy, Medication/Treatment Labeling and Storage, revised 7/2013 documented medications, when…

    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.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
Show the remaining 20 citations
  • Potential for harm · Dcited before2024-09-16 · tag F0677 — failed to help fully-dependent residents with daily care — isolated
    Provide care and assistance to perform activities of daily living for any resident who is unable.
    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 during the recertification and abbreviated (NY00336546) surveys conducted 9/9/2024- 9/16/2024, the facility did not ensure residents who were unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for 4 of 9 residents (Residents #2, #35, #37, and #64) reviewed. Specifically, Resident #2 was not provided with assistance during meals as planned; and Residents #35, #37, and #64 had unclean and untrimmed fingernails. Findings include: The facility policy, Activities of Daily Living, revised 10/2023, documented each resident would receive and the facility would provide necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being. Residents would be given the appropriate treatment and services to maintain or improve their ability to carry out activities of daily living including hygiene, mobility, elimination, dining,…

    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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-09-16 · tag F0679 — failed to provide activities — isolated
    Provide activities to meet all resident's needs.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, record review, and interview during the recertification survey conducted 9/9/2024-9/16/2024, the facility did not ensure ongoing provision of programs to support each resident and their choices of activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident for 1 of 2 residents (Resident #5) reviewed. Specifically, Resident #5 was not offered meaningful activities that included their interests and preferences. Findings include: The facility policy, Activity Department Programming, effective 1/1/2000, documented the activities department provided activities programs seven days a week and included individual, group, and independent activities. A visitation program designated to reach residents who would not or could not attend other activities was included. Activities reflected the interests listed on the initial assessment form. Resident #5 had diagnoses of bipolar disorder (a type of mental illness), depression, and spinal stenosis (narrowing of the spinal) of the lumbar (lower back) and thoracic…

    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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2024-09-16 · tag F0684 — failed to provide proper treatment and quality of care — isolated
    Provide 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

    Based on observation, record review, and interview during the recertification survey conducted 9/9/2024-9/16/2024, the facility did not ensure residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the resident's choices for 1 of 4 residents (Resident #120) reviewed. Specifically, Resident #120's physician ordered urinalysis (a laboratory test that examines urine for a variety of conditions) was not obtained timely. Findings include: The facility policy, Radiology and Other Diagnostic Services, revised 11/2016, documented the facility would provide or obtain diagnostic services to meet the needs of its residents pursuant to an order by an appropriate practitioner. The facility was responsible for the quality and timeliness of such services. Resident #120 had diagnoses of unspecified dementia, cerebral infarction (stroke), and hypothyroidism. The 7/10/2024 Minimum Data Set assessment documented the resident had severely impaired cognition, was incontinent of bladder and bowel, did not have 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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-09-16 · tag F0880 — failed to prevent and control infections — isolated
    Provide and implement an infection prevention and control program.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, record review, and interviews during the recertification survey conducted 9/9/2024-9/16/2024, the facility did not establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 of 2 residents (Resident #137) reviewed. Specifically, appropriate hand hygiene was not performed by Licensed Practical Nurse #31 during a wound care treatment for Resident #137. Findings include: The facility policy, Dressing-Clean Technique, revised 12/2007, documented a clean dressing technique was used to provide an appropriate and safe environment conducive to wound healing and should be used during all dressing changes unless otherwise specified by the physician, and gloves should be changed, and hands washed after the removal of a soiled dressing. Resident #137 had diagnoses including Parkinson's disease (a progressive neurological disorder) and a local infection of the skin and subcutaneous tissue. The 7/29/2024…

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

    Infection Control Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-09-16 · tag F0919 — failed to provide a working call system — isolated
    Make sure that a working call system is available in each resident's bathroom and bathing area.
    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 during the recertification survey conducted 9/9/2024-9/16/2024, the facility did not ensure they were adequately equipped to allow residents to call for staff assistance through a communication system which relayed the call directly to a staff member or to a centralized work area for 1 of 1 resident (Resident #90) reviewed. Specifically, Resident #90's call bell did not function as designed and they did not have the means of directly contacting caregivers. Findings include: The facility policy Call Lights, revised 10/24/2022, documented all residents would be provided with a method to communicate requests and needs, directly to staff or a centralized work area from the bedside, bathing, and bathroom areas through audible signals, visible signals, or electric/wireless systems. The facility would have a process to routinely ensure the call system for residents was operational. If a call light was defective, staff would report immediately to maintenance and 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.

    Environmental Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Fcited before2022-08-02 · tag F0584 — failed to keep a safe, clean, comfortable home — widespread
    Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
    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, interview, and record review during the extended and abbreviated surveys (NY00298775) conducted 7/25/22-8/2/22, the facility failed to ensure residents had the right to a safe, clean, comfortable, and homelike environment for 144 out of 144 residents including Residents #3, 12, 42, 53, 62, 78, 104 and 502 and for 1 additional resident area (beauty salon). Specifically, adequate hot water was not provided to resident rooms and shower rooms on all resident units (Units 2, 3, 4) and the beauty salon on floor 1. Review of the May 2022 Resident Council minutes included that the facility was getting a new boiler due to lack of hot water. The facility had several complaints regarding lack of hot water dating back to 2021. According to plant operation records, 1 of 3 hot water heaters supplying hot water to the facility became inoperable on June 7, 2022. The facility delayed addressing the lack of hot water and the Administrator stated they did not view a lack of hot water as an emergency. 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.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Ecited before2022-08-02 · tag F0677 — failed to help fully-dependent residents with daily care — pattern
    Provide care and assistance to perform activities of daily living for any resident who is unable.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview, and record review during the recertification and abbreviated surveys (NY00282793, NY00275980, NY00296065, NY00274624, NY00283438, NY00298775, NY00296718, NY00277703, and NY00277484) conducted 7/25/22-8/2/22, the facility failed to ensure residents who were unable to carry out activities of daily living (ADLs) received the necessary services to maintain good grooming and personal and oral hygiene for 11 of 17 residents (Residents #1, 24, 53, 55, 62, 63, 78, 82, 104, 112, and 149) reviewed. Specifically; - Resident #1 was not assisted with their preferred frequency of bathing and hair washing. - Resident #24 was not assisted with daily dressing. - Resident #53 received bed baths in place of preferred showers because the facility did not have warm water or a shower gurney available for resident use. -Resident #55 stated they did not receive a shower on their scheduled shower day and documentation did not include bathing. - Resident #62 was not assisted with combing and brushing their hair daily as preferred. - Residents #63 and 82 were not assisted out…

    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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Ecited before2022-08-02 · tag F0921 — failed to keep a safe, functional, sanitary building — pattern
    Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
    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, interview, and record review during the recertification and abbreviated surveys (NY00277703, NY00296718, NY00283438, NY00282793, NY00277484, NY00275980 and NY00274624) conducted 7/25/22-8/2/22, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public for 2 of 3 resident units (Units 3 and 4) and 2 resident rooms observed. Specifically, there were unclean floors on Units 3 and 4, unclean walls on Unit 4, unclean privacy curtains on Unit 3, room [ROOM NUMBER] had a strong urine odor, and room [ROOM NUMBER] had an unclean commode. Findings include: The facility policy Room Cleaning Procedures dated 5/2021, documented the facility would provide an environment that fostered a positive self-image for the resident and preserves human dignity. Sinks and toilets were cleaned with disinfectant cleaner inside and out, and flooring was dust mopped and then wet mopped with the specified floor cleaner. The following observations were…

    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.

    Environmental Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2022-08-02 · tag F0554 — isolated
    Allow residents to self-administer drugs if determined clinically appropriate.
    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 during the recertification survey conducted 7/25/22-8/2/22 the facility failed to determine the clinical appropriateness of self-administration of medications for 1 of 2 residents (Resident #55) reviewed. Specifically, Resident #55 had a bronchodilator inhaler (used to treat asthma) at their bedside, was not assessed to determine their ability to safely self-administer medications and did not have a physician order for self-medication. Findings include: The facility policy Self-Administration of Medications dated 11/23/21 documented: - Self-administration of medications was indicated by the team leader. - Continued approval of the self-administration of medications by the resident was dependent on the resident's compliance with physician orders and facility procedures. The facility policy Medication/Treatment Labeling and Storage revised 7/2013, documented: - Residents' medications/treatments were properly labeled by the pharmacy and when received in the nursing…

    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.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2022-08-02 · tag F0558 — failed to accommodate residents' needs and preferences — isolated
    Reasonably accommodate the needs and preferences of each resident.
    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 during the recertification and abbreviated (NY00277703) surveys conducted 7/25/22-8/2/22, the facility failed to ensure residents had the right to reside and receive services with reasonable accommodation of needs and preferences for 1 of 1 resident (Resident #53) who required a shower gurney (a mobile shower bed used to transport a person with limited body movement into a shower) for bathing. Specifically, Resident #53 was assessed as requiring a shower gurney for bathing safety, the plan of care did not reflect the need for a shower gurney, a shower gurney could not be located by staff, and the resident was not showered as requested and planned. Findings include: The facility policy Activities of Daily Living (ADLs) dated 11/2016 documented each resident would receive and the facility would provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, consistent with 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.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2022-08-02 · tag F0610 — failed to investigate and act on abuse reports — isolated
    Respond appropriately to all alleged violations.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on record review and interview during the recertification survey conducted 7/25/22-8/2/22, the facility failed to ensure that all allegations of abuse, neglect, exploitation, or mistreatment were thoroughly investigated for 1 of 1 residents (Resident #82) reviewed. Specifically, Resident #82 sustained a dislocated left shoulder and the investigation was not thorough and complete as there was no documented evidence the facility investigated possible causes of the dislocated shoulder; no documented evidence the facility ruled out abuse/neglect, and no documented evidence the facility determined whether the resident's comprehensive care plan (CCP) was followed when care was provided. Findings include: The facility policy Accident/Incident Report Investigation and Prevention revised 4/2015 documented the facility would conduct an immediate and thorough investigation upon discovery of an incident during the shift that the incident occurred. Resident #82 had diagnoses including dementia, osteoarthritis of both hips, and weakness. The 3/13/22 Minimum Data Set (MDS) assessment…

    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.

    Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2022-08-02 · tag F0656 — failed to write and follow a full care plan — isolated
    Develop 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 interview during the recertification survey conducted 7/25/22-8/2/22, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, that includes measurable objectives and timeframes to meet a resident's nursing needs for 1 of 1 resident (Resident #8) reviewed for bathing care plans. Specifically, Resident #8's care plan documented they required extensive assistance with bathing, and they showered themself without assistance. Findings include: The facility policy Activities of Daily Living (ADLs) dated 11/2016 documented each resident would receive and the facility would provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, consistent with the resident's comprehensive assessment and plan of care. A resident would be given the appropriate treatment and services to maintain or improve their ability to carry out ADLs including hygiene (bathing) and mobility…

    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.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2022-08-02 · tag F0776 — isolated
    Provide timely, approved x-ray services, or have an agreement with an approved provider to obtain them.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on record review and interview during the recertification and abbreviated surveys (NY00296799) conducted 7/25/22- 8/2/22, the facility failed to provide or obtain radiology or other diagnostic services to meet the needs of its residents; and be responsible for the quality and timeliness of the services for 1 of 2 residents (Resident #302) reviewed. Specifically, a STAT (emergent) X-ray of the right hip was ordered for Resident #302 on 5/29/2022 and it was not completed until 5/30/22 and the resident was diagnosed with a fractured right hip. Findings include: The facility policy Policy on Radiology and Other Diagnostic Services dated 1/1/2000 documented the facility should provide or obtain radiology and other diagnostic services to meet the needs of its residents pursuant to an order by an appropriate practitioner. The facility was responsible for the quality and timeliness of such services. Resident #302 had diagnoses including a fractured sacrum (triangular bone at the base of the vertebrae) and atrial fibrillation. The 5/16/22 Minimum Data Set (MDS) assessment 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.

    Administration Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Ecited before2019-11-07 · tag F0812 — failed to store, cook, and serve food safely — pattern
    Procure 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

    Based on observation, record review, and interview during the recertification survey, the facility did not store, prepare, distribute and serve food in accordance with professional standards for food service safety in the main kitchen. Specifically, 3 cracked eggs were stored in an egg carton container that were leaking onto the carton of eggs below, a reach-in cooler had several pans of outdated food, the walk-in freezer had 2 inches of uneven ice buildup on the floor, and 3 boxes of food were encased within ice. Findings include: The facility's Receivable and Storage Policy, dated 1/2017, documents all foods are to be securely covered, dated, and labeled. The policy did not document how long food and beverages could be stored prior to being discarded. The work order dated 10/2/19, documented the walk- in freezer was leaking water and was serviced on 9/27/19 and rechecked on 9/30/19. The work order dated 11/4/19, documented the walk-in freezer had a buildup of condensation, water was leaking all over, and was serviced on 10/11/19. On 11/4/19 at 9:10 AM, the following was observed…

    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.

    Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2019-11-07 · tag F0813 — pattern
    Have a policy regarding use and storage of foods brought to residents by family and other visitors.
    What the surveyor found here — the official record, unedited, may be distressing

    Based on record review and interview during the recertification survey, the facility did not ensure a policy was developed regarding use and storage of foods brought to the residents by family and other visitors to ensure safe and sanitary storage, handling, and consumption. Specifically, the facility did not ensure the policy included a process for assisting residents in accessing and consuming the food if a resident was unable to do so on his or her own. Findings include: The facility policy titled Personal Food Storage, revised 2/2/2017, did not include documentation of a process for assisting residents in accessing and consuming the food if a resident was unable to do so on his or her own. During an interview on 11/6/19 at 2:30 PM, the Regional Food Service Director stated he was aware the policy needed to include a process for assisting residents in accessing and consuming the food if a resident was unable to do so on his or her own and the current policy did not include that process. 10 NYCRR 415.14(h)

    Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2019-11-07 · tag F0550 — failed to protect resident dignity and rights — isolated
    Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
    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 and interview during the recertification survey, the facility did not ensure each resident was treated with respect and dignity for 1 of 2 residents (Resident #22) reviewed for dignity. Specifically, two staff members referred to Resident #22 in a disrespectful and undignified manner during a dining service. Findings include: The 4/2019 facility Dignity Policy documents: - Residents are to be respected by speaking respectfully, addressing the resident by the name of his/her choice, and avoid using labels for residents such as feeders. Resident #22 was admitted to the facility on [DATE] and had diagnoses including dementia, legal blindness, and major depressive disorder. The 8/8/19 Minimum Data Set (MDS) assessment documented the resident had adequate hearing, understood others, had severe cognitive impairment, and required extensive assistance of one person for eating. The undated [NAME] (certified nurse aide, CNA, care instructions) documented the resident was to eat all meals in 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.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2019-11-07 · tag F0657 — failed to keep the care plan current — isolated
    Develop 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 review and Interview during the recertification survey, the facility did not ensure residents participated in the development of their comprehensive care plans for 1 of 2 residents (Resident #94) reviewed for care plans. Specifically, Resident #94 was not invited to participate in her annual (comprehensive) care plan review meeting. Findings include: The facility's Care Planning Interdisciplinary Team policy, dated 2/21/19, documents: - Each resident and his/her family members and/or legal representative shall be permitted to participate in the development of the resident's comprehensive care plan (CCP). - The care plan is developed by a care planning/interdisciplinary teams which includes, to the extent possible, the resident, the resident's family or legal representative who should participate in the development of the care plan. Resident #94 was admitted to the facility on [DATE] and had diagnoses including hemiplegia (paralysis of one side of the body) due to stroke and contracture of muscle,…

    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.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2019-11-07 · tag F0692 — failed to prevent malnutrition and dehydration — isolated
    Provide enough food/fluids to maintain a resident's health.
    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, interview, and record review during the recertification survey, the facility did not ensure each resident maintained acceptable parameters of nutritional status for 2 of 2 residents (Residents #4 and 105) reviewed for nutrition. Specifically, Resident #4 was not provided all her meal items per her meal plan and her consumption was not accurately documented. Resident #105 did not receive his nutritional supplement as ordered. Findings include: The facility's Clinical Nutrition/Dietary Policy revised 8/30/16 documents: - The purpose is to ensure that each resident is receiving menu items of their choice, within their current diet order. - To ensure all resident are provided with adequate nutrition based on their physician prescribed diet orders. 1) Resident #4 was admitted to the facility on [DATE] and had diagnoses including vascular dementia, osteoarthritis, and macular degeneration. The 10/26/19 Minimum Data Set (MDS) assessment documented the resident had moderate cognitive impairment,…

    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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2019-11-07 · tag F0730 — isolated
    Observe each nurse aide's job performance and give regular training.
    What the surveyor found here — the official record, unedited, may be distressing

    Based on record review and interview during the recertification survey, the facility did not ensure certified nurse aide (CNA) performance reviews were completed at least once every 12 months for 2 of 2 CNAs (CNA #12 and 13) reviewed during the New York State Department of Health Nurse Aide Training Program review. Specifically, CNAs #12 and 13 did not have performance reviews documented at least once every 12 months. Findings include: The Certificate for Graduation from the CNA training program for CNA #12 was May 2018 and the Certificate for Graduation from the CNA training program for CNA #13 was August 2017. There was no documented evidence CNAs #12 and 13 had performance reviews completed at least once every 12 months. On 11/7/19 at 1:30 PM, the facility CNA Program Coordinator stated there was not an annual performance review available for CNAs #12 and 13. She was not responsible for the annual performance review of the CNAs. She said she had spoken to the Human Resources Director and they did not have a performance review for CNAs #12 and 13. 10NYCRR 415.26 (d) (7)

    Nursing and Physician Services Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2019-11-07 · tag F0921 — failed to keep a safe, functional, sanitary building — isolated
    Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation and interview during the recertification survey, the facility did not provide a safe, functional environment for residents and staff for 1 isolated area (third floor short hall tub room). Specifically, the third-floor short hall tub room had a hole in the floor and the access panel door for the tub was opened and not secured. Findings include: During an observation on 11/5/19 at 10:35 AM, the floor within the third-floor short hall tub room had an approximate 4-inch circular hole in it, and the access panel door for the tub was opened and not secured. A drain line ran through this hole below the floor, and a tennis ball was found within this hole. Although the access panel door was opened, the lock was in the locked position. During an interview on 11/6/19 at 4:10 PM, the Plant Operations Director stated he was not aware that the tub in the third-floor short hall tub room had been pulled away from the wall and was not aware that there was a hole in the floor. No staff had told him about the hole in the floor or of the opened and unsecured access panel door to…

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

    Environmental Deficiencies · Deficient, Provider has date of correction

“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.

Worried about a resident here? There are three different people you can turn to, and they do different jobs:
  • 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.
Not sure where to start, or need other help? Dial 2-1-1 for local resources — and if a call is hard or impossible for you, many local 211s also take a text (send your ZIP code to 898-211) or a web chat at 211.org; both vary by area, and 211.org will show what yours offers. Deaf or hard of hearing: dial 711 for the telecommunications relay service, then any number above. In an emergency, call 911.
It is illegal for a facility to retaliate against a resident or family for reporting a concern: federal law gives a resident the right to voice grievances — to the home or to any outside agency — without discrimination or reprisal (42 CFR §483.10(j)(1)). You may report anonymously.

Fines & penalties

$32,321 in federal fines across 1 penalty.

  • $32,321 — penalty dated 2024-09-16

Dates are the dates CMS records the penalty, not the date of the conduct behind it. CMS publishes penalties on a rolling window, so this is what is currently on the public file — not the home’s lifetime history, and an older fine may attach to a problem that has since been corrected. The amounts are as imposed: the CMS file does not record whether a penalty was appealed, reduced, or paid, so we don’t say. Ask the home what each one was for and what changed since.

Who owns this facility

Owner / managerTypeRoleShareSince
282 RIVERSIDE LLCOrganization5% OR GREATER DIRECT OWNERSHIP INTEREST100%since 02/07/2005
BACCHI, ANTHONYIndividual5% OR GREATER INDIRECT OWNERSHIP INTEREST31%since 02/07/2005
FARBENBLUM, EDWARDIndividual5% OR GREATER INDIRECT OWNERSHIP INTEREST; OPERATIONAL/MANAGERIAL CONTROL46%since 06/18/2018
LEBOVICH, TIBORIndividual5% OR GREATER INDIRECT OWNERSHIP INTEREST14%since 02/07/2005
AHMAD, RANAIndividualCONTRACTED MANAGING EMPLOYEEsince 01/01/2024
REEDY, TIMOTHYIndividualW-2 MANAGING EMPLOYEEsince 01/01/2024
ROSSO, RALPHIndividualCORPORATE OFFICERsince 01/01/2024
PHAN, TOMIndividualOPERATIONAL/MANAGERIAL CONTROLsince 01/01/2020

CMS files one row per role, so the 9 rows in the source record cover these 8 parties — each is shown once here with every role it holds. Nothing is omitted.

1 organizational owner 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.

$17.4M
Net patient revenuemost recent cost report
+4.3%
Operating marginrevenue minus expenses
$1.3M
Related-party expense8% of expenses
Who pays — share of resident-days
Medicaid 78%Medicare 8%Other / private 14%

About 78% of this home’s resident-days are paid by Medicaid, which reimburses well below the cost of care in most states. Heavily Medicaid-dependent homes run on thinner budgets — a context worth holding next to the staffing and inspection record, not a fault in itself. This home reported $1.3M paid to related parties (affiliated landlords or management companies) in its most recent 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

$308per resident / day
operating cost
$9,353per month
≈ monthly operating cost
$321per day
avg. revenue, all payers

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

Paying with Medicaid

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.

Typical monthly cost in New York
$15,528/mo
Nursing home (semi-private)
$16,729/mo
Nursing home (private)
$7,110/mo
Assisted living

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 335393. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2024-09-16, 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 →

Are you this operator? If the record here is out of date, or misses what you have since fixed, tell us and we will look: hello@eldercarelens.com. We reproduce the public CMS record and cannot change what it says — corrections to the underlying data go through CMS and your state survey agency — but we will correct anything we have got wrong about it, and we will say so on the page.

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