Wedgewood Nursing and Rehabilitation Center

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record review conducted during the Recertification Survey and complaint investigation (Intake ID: 2673831), the facility did not provide housekeeping and maintenance services necessary to maintain a safe, clean, comfortable, and homelike environment for 9 of 15 resident rooms (Rooms #11, #13, #14, #15, #16, #17, #21, #22, and #23) and one (1) of one (1) ventilation system. Specifically, there were damaged baseboard radiators, exhaust ventilation was not functional resulting in foul odors, boxes of supplies were stored outside in the snow, there was a damaged electrical outlet cover, and a bathroom faucet was corroded. The findings include: Observations on 02/09/2026 at 9:10 AM included approximately eight (8) boxes of Medline supplies setting on a wooden pallet, covered with snow outside the loading dock. Observations on 02/10/2026 at 9:22 AM included a wooden pallet outside the loading dock with multiple boxes of supplies with snow on top, including but not limited 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record review conducted during an Abbreviated Survey (Intake ID: 2656534, 2667467, and NY00382089/820392) completed on 12/04/2025, for one (1) of one (1) residential unit, the facility did not provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, comfortable, and homelike environment. Specifically, there were heavy urine and bowel odors upon entering the facility and, in the hallways, floors were dirty and/or in disrepair, walls had missing paint, a hand soap dispenser was broken, two (2) apex (a device used to assist residents with standing) machines were dirty and had duct tape on the frames, and the dumbwaiter (a small freight elevator used for moving items, such as laundry and food) was dirty. Additionally, the shower room was in disrepair and bathing fixtures were not available for resident use at a ratio of 1 per 20 residents. The findings are:The facility policy Use of Dumbwaiter for Soiled Laundry and Food Transport dated…

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 observations, interviews and record review conducted during an Abbreviated Survey (Intake ID: 2621922 and 2626565) completed on 12/04/2025, for one (1) (Resident #3) of three (3) residents reviewed, the facility did not ensure each resident is treated with respect and dignity and cared for in a manner and in an environment that promotes maintenance or enhancement of their quality of life. Specifically, Resident #3 was observed in the dining room for several hours with a strong odor of bowel incontinence while in the presence of other residents. Additionally, Resident #3 requested to go to their room and staff yelled at the resident in a loud, demeaning tone and multiple residents were observed in the dining room and hallways wearing hospital gowns. The findings include:The facility policy Quality of Life - Dignity dated August 2009 included each resident shall be cared for in a manner that promotes and enhances quality of life, dignity, respect and individuality. Residents shall be treated with respect and dignity at all times and shall be encouraged and assisted to dress…

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 observations, interviews and record review conducted during an Abbreviated Survey (Intake ID: 2626565, NY00382613/820391) completed on 12/04/2025, for two (2) (Residents #3 and #8) of two (2) residents reviewed, 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. Specifically, for Resident #3 staff did not perform hand hygiene after assisting with incontinence care and prior to touching multiple surfaces and equipment. For Resident #8, the facility did not appropriately implement the use of Enhanced Barrier Precautions (EBP, an infection control strategy that uses gloves and gowns during high contact resident care to reduce the spread of infection) and there was an observation of staff not using personal protective equipment (PPE; equipment, such as gown and gloves, worn to protect individuals and reduce the risk of exposure…

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 observations, interviews and record review conducted during an Abbreviated Survey (Intake ID: 2621922, 2656534, NY00382613/820391, and NY00384361/820393) completed on 12/04/2025, for one (1) (Resident #3) of nine (9) residents reviewed, the facility did not ensure residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices. Specifically, Resident #3 was not checked or changed for extended periods, was observed in the dining room with a strong bowel odor for several hours and was later found with a saturated brief and non-disposable incontinence pad inside the brief, with redness noted to the buttocks. Furthermore, the facility did not revise Resident #3's care plan to address their chronic loose stools and increasing incontinence care needs, and staff documentation did not reflect care consistent with the resident's needs or the facility's required frequency of incontinence care.The findings include:The undated facility policy Activities of Daily Living (ADL), Supporting…

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 observations, interviews, and record review conducted during a Recertification Survey it was determined that for five (rooms # 11, 12, 15, 18, and 19) of 15 resident rooms and one of one shower room, the facility did not provide housekeeping and maintenance services necessary to maintain a safe, clean, comfortable, and homelike environment. Specifically, floor tiles were cracked and damaged, and hot water in a shower room was not maintained above 90 degrees Fahrenheit (°F). The findings are: The facility policy titled: 'Water Temperatures, Safety of' included that water heaters that service resident rooms, bathrooms, common areas, and tub/shower areas shall be set to temperatures of no more than 90°F (120 °C), or the maximum allowable temperature per state regulation. Observations on 3/11/24 at 9:32 AM included the floor tiles in resident rooms #12 and #15 had multiple chips and cracks throughout the room and at the door thresholds. In resident room [ROOM NUMBER] there were two approximately 12-inch by…

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 observations, interviews, and record review conducted during the Recertification Survey, it was determined that for six (rooms #10, 12, 14, 16, 18, and 19) of 15 resident rooms, the facility did not ensure that the resident environment remained free of accident hazards. Specifically, hot water temperatures exceeding 120 degrees Fahrenheit (°F) were accessible to residents at point of use locations. The findings are: The facility policy titled: 'Water Temperatures, Safety of' included that water heaters that service resident rooms, bathrooms, common areas, and tub/shower areas shall be set to temperatures of no more than 90°F (120 °C), or the maximum allowable temperature per state regulation. Observations on 3/11/24 at 9:44 AM included the in-line temperature gauge for outgoing water from the mixing valve located in the basement boiler room displayed a temperature of 130°F. During an interview at this time, the Director of Environmental Services stated that the hot water temperature should be 120°F or less, and that by the time the water gets to the unit it's usually lower.…

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 Recertification Survey the facility did not ensure that appropriate treatment and services were provided to prevent urinary tract infections for a resident with an indwelling urinary catheter (tube inserted into the bladder to drain urine into a drainage bag) for one (Resident #10) of one resident reviewed. Specifically, Resident #10 had a history of urinary tract infections and was observed on multiple occasions with the urinary catheter drainage bag, catheter drainage port, and catheter tubing lying directly on the floor in the resident's room and in the therapy room. The finding is: The policy and procedure, Foley Catheter Care/Suprapubic Catheter Care, dated 11/7/18 documented the purpose of the procedure was to prevent catheter associated urinary tract infections. Additionally, the urinary drainage bag must be held or positioned lower than the bladder at all times to prevent the urine in the tubing and drainage bag from flowing back into the bladder, use standard precautions (infection prevention practices…

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 observations and interviews conducted during the Standard Recertification Survey completed on 6/17/22, it was determined that for one of one main kitchen, the facility did not store, prepare and distribute food in accordance with professional standards for food service safety. Specifically, there was a significant build-up of ice in a reach in freezer, sink plumbing was leaking, a freezer had a torn gasket, and a sink without an indirect drain was being used for food preparation. This is evidenced by the following: 1. Observations during the initial brief tour of the kitchen on 6/14/22 from 8:22 a.m. to approximately 9:22 a.m. revealed the following: a. A 'True' brand 2-door stand-up freezer had a significant accumulation of ice under the evaporator fans. b. The cold-water pipe for the single bay stainless steel prep sink was leaking, and this prep sink was covered with a metal plate. During an interview at this time the Food Service Director stated that they do not use the prep sink and acknowledged…

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 observations and interviews conducted during the Recertification Survey, it was determined that for one of one main kitchen, the facility did not provide food that was palatable, attractive, or at an appetizing temperature. Specifically, the [NAME] did not follow the menu or the recipe for the main entrée of chicken and biscuits. This is evidenced by the following: The facility provided the lunch menu and recipe for the chicken and biscuits for lunch on 3/1/20. Make one pouch of chicken gravy, add one bag of cooked, diced chicken, and three cups of mixed vegetables and heat until 165 degrees Fahrenheit. Serve over a warm biscuit, split in half. The remaining items for the meal were capri blend vegetables, fruit cocktail, and banana cream pie for dessert. During an observation of the lunch meal on 3/1/20 at 12:34 p.m. and 1:05 p.m. in the main dining room, the residents had been served biscuits and diced chicken with no gravy or vegetables in the chicken and biscuit entrée. Seven of ten residents did not eat the chicken, and three residents said that the chicken was not…

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 observations and interviews conducted during the Recertification Survey, it was determined for one of one main kitchen the facility did not store, distribute, or serve food under sanitary conditions. The issues included a defective rinse temperature gauge on the dish washing machine, frozen packages opened and undated, and items stored on the floor in the dry storage room. This is evidenced by the following: During the initial tour of the kitchen on 3/1/20 at 9:20 a.m., there were three racks of bread, three cases of paper and plastic plates, and two cases of V-8 juice stored on the floor in the dried storage room. There were opened and undated frozen items in the freezer including cubed chicken meat patties, hotdogs, cheese raviolis, and undated cooked bacon. In an observation at 12:00 p.m., the rinse temperature gauge was not working. The vendor work order, dated 10/18/19, revealed that the dish washing machine rinse temperature gauge was defective and needed to be replaced. The facility did not have a log that recorded the dish washing machine rinse temperatures. 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.

Based on observations and interviews conducted during the Recertification Survey, it was determined that the facility did not safeguard medical record information against loss, destruction or unauthorized use. Specifically, medical records were not secured. This is evidenced by the following: In observations throughout the day on 3/1/20 and 3/2/20, there were three unlocked file cabinets that contained medical records located in an area near the main entrance of the facility that was accessible to anyone. There were also medical records on top of the file cabinets and on the floor near the cabinets. Interviews conducted on 3/2/20 included the following: a. At 8:50 a.m., the Licensed Practical Nurse stated the filing cabinets have been stored in that entry way area for several months. She said the fire panel was alarming one day and several medical records were knocked all over the floor. b. At 8:53 a.m., the Administrator said the receptionist was responsible for the storage and maintenance of the medical records. He observed the stacks of medical records and unlocked file cabinets,…

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.