Bishop Rehabilitation And Nursing Center

Location & what’s nearby

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Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.

Quality measures — how residents actually fare

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.

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.

26.5% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — CMS rates that worse than the national rate. This is CMS’s risk-adjusted rate over 90 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

Met the expected recovery: 30.6% of this home’s Medicare short-stay residents left it at or above the ability to care for themselves and move around that CMS predicted for them, across 36 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 0.25 therapist hours per resident per day in 2026Q1 — more than 34% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 11% of this home’s weekday level — it runs some therapy at the weekend, at a lower level than on weekdays. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.

This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.

Staffing

How full it usually is: this home is certified for 440 beds and averages 295.7 residents a day — about 67% occupied, or roughly 144 beds typically open. It often has substantial empty capacity — worth asking why, since low census can reflect either a new or shrinking home or one families are avoiding. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.

Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 3.52 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 0.33 is below the 0.55-hour RN benchmark and nurse-aide staffing of 2.19 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 2.88 hrs/resident/day on weekends vs 3.77 on weekdays — 24% thinner on weekends — a notable drop. RN hours go from 0.39 to 0.18 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 56% is about the same as 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

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.

Inspection deficiencies

State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.

Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.

50 citations, most serious first. The 20 most serious are shown; the remaining 30 are one tap away and print in full.

• Immediate jeopardy · K2024-07-11 · tag F0697 — failed to manage pain — pattern
  Provide safe, appropriate pain management for a resident who requires such services.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation, record review, and interviews during the extended recertification survey conducted 6/4/2024-7/11/2024, the facility failed to ensure that pain management was provided to residents who required such services consistent with professional standards of practice for 3 of 7 residents (Resident #28, #37, and #64) reviewed. Specifically, -Resident #28's physician ordered pain cream was not administered as ordered and was documented as administered. -Resident #37 did not receive Lyrica (used to treat nerve and muscle pain) as ordered for 3 days; -Resident #64 was not aware of an as needed order for acetaminophen (pain reliever) and pain cream and was not offered the medications when in pain. Subsequently, Residents #28, #37, #64 had unresolved pain that affected their daily functional abilities, psychosocial well-being, and diminished quality of life. This placed all residents with pain, who received pain medication, at risk for harm that was Immediate Jeopardy and Substandard Quality of Care. Findings include: The facility policy, Pain Management, revised 3/2020,…

  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
• Immediate jeopardy · K2024-07-11 · tag F0745 — failed to provide medically-related social services — pattern
  Provide medically-related social services to help each resident achieve the highest possible quality of life.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation, interview, and record review during the extended recertification and abbreviated (NY0033160) surveys conducted 6/4/2024-7/11/2024, the facility failed to provide medically related social services to attain or maintain the highest practicable physical, mental, and psychosocial well-being for 5 of 5 residents (Resident #41, #126, #153, #235, and #250) reviewed. Specifically: - Resident #41 had an extensive mental health history, did not have person-centered mental health interventions, and was seen by a licensed psychologist and their recommendations were not implemented into the resident's plan of care. There were no documented social services follow ups with the resident following their behaviors. - Resident #126 had a significant mental health history and did not have person-centered mental health interventions for their behaviors or refusals of care and medications. There were no documented social services follow ups with the resident following their behaviors. - Resident #153 was seen by a licensed psychologist and their recommendations were not implemented…

  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
• Immediate jeopardy · K2024-07-11 · tag F0773 — pattern
  Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on record review and interview during the extended recertification and abbreviated (NY00335379) surveys conducted 6/4/2024-7/11/2024, the facility failed to ensure the ordering physician was notified promptly when a laboratory result fell outside of clinical reference range for 3 of 3 residents (Residents #153, #260, and #529) reviewed. Specifically, - Resident #529 had abnormal laboratory results including a high white blood cell count, a low lymphocyte count, and high sodium, blood urea nitrogen, and blood urea nitrogen/creatinine ratio (indicating possible dehydration and infection) that were not reviewed by facility staff in a timely manner, and the medical provider was not notified in a timely manner of the abnormal lab results. Subsequently, the resident was hospitalized 3 days later with pneumonia and dehydration. - Resident #153 had a critically low blood glucose (blood sugar) of 49 milligrams/deciliter and the provider was not notified in a timely manner and the resident was not assessed. - Resident #260 had a high international normalized ratio (INR, used 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.

  Administration Deficiencies · Deficient, Provider has date of correction
• Actual harm · I2024-07-11 · tag F0580 — failed to tell family and doctor about changes — widespread
  Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation, record review, and interview during the extended recertification and abbreviated (NY00331669) surveys conducted 6/4/2024-7/11/2024, the facility did not ensure the physician was consulted and the resident's representative was notified when there was a significant change in the resident's physical, mental, or psychosocial status for 4 of 4 residents (Residents #37, #147, #153, and #528) reviewed. Specifically: - Resident #37 did not receive their Lyrica (used to treat nerve pain) on the day shift (7:00 AM-3:00 PM from 6/22/2024-6/24/2024 due to the facility not having the medication and the provider was not notified. Subsequently, the resident had complaints of uncontrolled pain. - Resident #147 refused heparin (a blood thinner), insulin (used to treat diabetes), and labs as ordered for a period of 6 months, the medical provider was not notified and there was not an assessment by the provider to determine the outcome of the refusals. - Resident # 153 had a critically low blood glucose level reported to the facility by the contracted laboratory service on…

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

  Resident Rights Deficiencies · Deficient, Provider has date of correction
• Actual harm · Icited before2024-07-11 · tag F0658 — failed to meet professional standards of care — widespread
  Ensure services provided by the nursing facility meet professional standards of quality.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation, record review, and interview during the extended recertification and abbreviated (NY00335306, NY00334736, NY00331600, NY00335937, NY00337529, NY00340292, NY00340725, and NY00335379) surveys conducted 6/4/2024-7/11/2024, the facility did not ensure services provided met the professional standards of quality in 5 of 5 areas (pressure ulcers, medication administration, respiratory care, activities of daily living, and laboratory testing notifications). Specifically, medication administration was not completed in accordance with accepted standards of clinical practice (see F 554); provider notification was not completed for residents with significant changes in condition (see F 580); oral care and feeding assistance was not completed as ordered or planned (see F 677); pressure ulcer prevention services were not completed as ordered (see F 686); splints were not applied as ordered (see F 688); recommendations for appetite stimulant were not discussed with the provider for a resident with significant weight loss (see F 692); respiratory equipment was not maintained…

  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
• Actual harm · Hcited before2024-07-11 · tag F0686 — failed to prevent and treat pressure sores (bedsores) — pattern
  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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review, and interviews during the extended recertification and abbreviated (NY00335306) surveys conducted 6/4/2024-7/11/2024, the facility failed to ensure that a resident with pressure ulcers received necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection, and prevent new ulcers from developing for 4 of 7 residents (Residents #222, #265, #271, and #826) reviewed. Specifically, Resident #826 had pressure injuries that were not assessed, and was not provided treatments to promote healing. Subsequently, Resident #826 was admitted to the hospital with a chronic sacral osteomyelitis (inflammation of bone tissue related to infection) with overlying cellulitis (skin infection). The resident underwent surgical debridement (removal of dead tissue), was in a great deal of pain, was unable to sit, which hindered their ability to attend dialysis while in the hospital. Resident #271 developed a deep tissue injury after orders…

  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
• Actual harm · Hcited before2023-12-05 · tag F0550 — failed to protect resident dignity and rights — pattern
  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 and abbreviated (NY00327344) surveys conducted 11/27/2023-12/5/2023, the facility did not treat each resident with respect and dignity and care for each resident in a manner and in an environment that promoted maintenance or enhancement of quality of life for 4 of 5 residents (Residents #31, #109, #121, and #522) reviewed. Specifically, Resident #31 did not receive toileting assistance and was observed lying in a urine soaked incontinence brief (refer to F 677 ADL Care for Dependent Residents); Resident #109 did not have appropriate footwear for community visits outside the facility and had bed linens that were in poor condition, resulting in the resident feeling humiliated (refer to F 684 Quality of Care); Resident #121 did not have an outpatient follow up visit with hematology/oncology for a positron emission tomography scan (an imaging test used to detect diseased cells) as ordered after being diagnosed with a pancreatic mass; and Resident #522 was restricted from going out on pass (leaving 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
• Actual harm · Hcited before2023-12-05 · tag F0684 — failed to provide proper treatment and quality of care — pattern
  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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and interview during the recertification and abbreviated surveys (NY00323973, NY00324500, NY00324681, NY00325947, NY00326310, and NY00327344) conducted 11/27/2023-12/5/2023, the facility failed to ensure residents received treatment and care in accordance with professional standards of practice for 9 of 11 residents (Residents #4, #18, #21, #55, #85, #121, #239, #265, and #521) reviewed. Specifically, -Resident #18 had blood glucose levels that were outside of parameters and medical was not notified as ordered. (Refer to F 600 Free from Abuse and Neglect) -Resident #21 had an unwitnessed fall, neurological checks (evaluation of nervous system functioning) were not completed, and the medical provider was not notified. -Resident #121 did not have a urology consult and positron emission tomography scan (an imaging test used to diagnose a disease) ordered and scheduled as recommended (Refer to F 550 Resident Rights) - Resident #239 had a wound dressing that was not changed 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
• Actual harm · G2023-12-05 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation, record review, and interview during the recertification and abbreviated (NY00324500) surveys conducted 11/27/2023-12/5/2023 the facility failed to ensure residents were free from neglect for 2 of 6 residents (Residents #18 and 31) reviewed. Specifically, Resident #18 had blood glucose levels that were outside of parameters and medical was not notified as ordered. The resident continued to have high blood glucose levels and was sent to the hospital for evaluation (Refer to F 684 Quality of Care). Resident #31 was not assisted with toileting per their care plan and as requested resulting in the resident being incontinent and being told to defecate in a brief (Refer to F 677 Activities of Daily Living Care). This resulted in actual harm of emotional distress from neglect of care to Resident #31 and hospitalization of Resident #18. Findings include: 1) Resident #31 had diagnoses of lumbar radiculopathy (a disease involving a spinal cord nerve root), cervical disc disorder (disorder of the bones in the neck), and depression. The 11/2/2023 Minimum Data Set 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
• Actual harm · G2023-12-05 · tag F0622 — isolated
  Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.
  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 and abbreviated surveys (NY00325947) conducted 11/27/2023-12/5/2023, the facility failed to ensure the development of an effective transfer or discharge planning process including documentation in the resident's medical record and appropriate communication with the receiving health care institution for 1 of 1 (Resident #265) resident reviewed. Specifically, Resident #265 was admitted to the facility and did not receive medications timely and was sent to a local acute care hospital emergency department the same day without a physician's order, and without comprehensive information for the acute care hospital to provide adequate care for the resident. The resident was denied admission back to the facility, after being discharged from the acute care hospital emergency department. This resulted in psychosocial harm to Resident #265 that was not immediate jeopardy. Findings include: The facility policy titled Discharge-Transfer/Discharge Process revised…

  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 · D2026-05-12 · tag F0694 — isolated
  Provide for the safe, appropriate administration of IV fluids for a resident when needed.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on record review and interviews (#2994892) the facility failed to ensure intravenous fluids (fluids that were administered directly into a vein) were administered consistent with professional standards of practice and in accordance with physician orders. This was identified for one (1) of two (2) residents (Resident #1), reviewed for hydration and receiving intravenous therapy. Specifically, Resident #1 had an order for fluids via intravenous route, the fluids were not provided as ordered, and the resident received 1000 cubic centimeters all at once, instead of over time. Nursing staff did not monitor the rate of the fluid infusion. The physician telephone order was not transcribed as an order and was not included on the Medication Administration Record and was not documented as administered. A facility investigation was completed on whether the correct fluid was administered but did not address these concerns.Findings include:The facility's Intravenous Infusion Therapy policy, last reviewed April 2026, documented the physician's order for intravenous therapy must be verified…

  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 before2026-05-05 · tag F0686 — failed to prevent and treat pressure sores (bedsores) — widespread
  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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review, and interviews (IQIES 2984903), 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 five (5) of seven (7) residents (Residents #4, # 8, #13, #100, and #209) reviewed. Specifically: - Resident #8 had multiple pressure ulcers including a Stage 4 (full thickness tissue loss with exposed bone, tendon, or muscle) pressure ulcer on the sacrum (lower back between the hip bones) that were not routinely assessed (determining stage, size and wound characteristics, appropriateness of treatment) by a qualified individual; newly identified pressure ulcers were not assessed by a qualified individual; pressure ulcer status was determined by a non-qualified individual and the wound evaluations were inconsistent and either included pressure ulcers not previously documented or did not 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.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Fcited before2026-05-05 · tag F0812 — failed to store, cook, and serve food safely — widespread
  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 observations and interviews, the facility failed to store food in accordance with professional standards for food service safety and did not follow proper sanitation practices to prevent the outbreak of food borne illness in one (1) of one (1) main kitchen and one (1) unit refrigerator (D South). Specifically, ten pans of prepared or leftover food in walk in coolers were not labelled; ten pans of fish were prepared and not labelled or dated; the dish machine wash temperature did not reach the required temperature; the dish machine sanitizer concentration was not monitored; Assistant Administrator #16 was in the main kitchen without a beard cover; there was debris and dried food built up on the floor and along the walls in the coolers and production areas; the reach in cooler gaskets had built up dried residue; and the unit refrigerator on D South had a dried sticky substance.Findings include:The facility policy Food Storage, revised 05/2024, documented all food would be clearly labeled and dated to assure that foods (including leftovers) would be consumed by their safe use…

  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 · F2026-05-05 · tag F0908 — failed to keep essential equipment working — widespread
  Keep all essential equipment working safely.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observations and interviews, the facility failed to maintain all mechanical, electrical, and patient care equipment in safe operating condition in one (1) of one (1) main kitchen. Specifically, the main kitchen walk-in freezer had ice built up on the floor and the compressor was leaking. Findings include:The facility policy Food Storage, revised 05/2024, documented all freezer units would be kept clean and in good working condition. Freezer temperatures should be checked at least two times each day and proper unit functioning would be checked at each temperature check. The facility policy Equipment Failure and Repair, revised 03/2022, documented staff was trained to report equipment that did not work or was not functioning properly to maintenance. Outside repair service would be called if problem could not be corrected in a reasonable time frame by facility maintenance staff.The 04/29/2026 vendor Duffy's AIS invoice stated the walk-in freezer was serviced on 04/28/2026 for extensive ice built up on the floor under the condenser. The unit was working properly, and the door…

  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 · E2026-05-05 · 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 observations and interviews the facility failed to ensure drugs and biologicals were labeled and stored in accordance with currently accepted professional standards and principles for two (2) of twelve medication carts (Unit C North and Unit 3 medications carts) and one (1) of two (2) treatment carts (Unit C South) reviewed. Specifically, the Unit C North medication cart was unlocked and unattended and contained pre-poured medications, expired eye drops and inhalers, and unlabeled insulin; the Unit 3 South medication cart had open unlabeled lidocaine (anesthetic) and expired insulin pens; and the Unit C South treatment cart was unlocked and unattended and contained scissors, antifungal cream, and antiseptics.Findings included:The facility policy Medication Storage and Labeling, last reviewed 01/21/2026, documented medications were stored safely and securely in a locked cabinet, cart or medication room that was accessible only to licensed nursing staff. Expired medications were removed from the medication storage areas and disposed of in accordance with state and federal…

  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 · Ecited before2026-05-05 · 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 observations and interviews, the facility failed to ensure residents were provided food and drink that was palatable, flavorful, and at an appetizing temperature for two (2) of two (2) test trays (04/28/2026 lunch and 04/29/2026 breakfast); and 12 of 17 anonymous residents present at the Resident Council meeting and two (2) of two (2) residents (Residents #346 and #20) interviewed. Specifically, the 04/28/2026 lunch tray and the 04/29/2026 breakfast tray included hot foods served below 140 degrees Fahrenheit and cold foods served above 41 degrees Fahrenheit and were not palatable; 12 anonymous residents at the Resident Council meeting stated the food was cold and overcooked; and Residents #346 and #20 stated the food was not palatable.Findings include: The facility policy Food Temperatures, dated 5/28/2025, documented hot food would be served at no less than 140 degrees Fahrenheit and cold food would be served no higher than 41 degrees Fahrenheit. Appropriate food transport equipment to maintain safe temperatures would be utilized. During an interview on 04/27/2026 at 11:05…

  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 before2026-05-05 · tag F0584 — failed to keep a safe, clean, comfortable home — isolated
  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 observations, record review, and interviews (IQIES intake 2799654), the facility failed to ensure a safe, clean, comfortable, and homelike environment for four (4) of seven (7) resident units (Units 2, A, D and C) and one (1) of one (1) resident (Resident #333) reviewed. Specifically, Resident #333 was not provided with a key to a nightstand drawer to secure valuables; Units A and D had clogged, sinks with foul smelling water; Unit C had areas that were unclean and in disrepair: and Unit 2's tub room had an active leak. Findings include:The facility policy Homelike Environment, dated 9/19/2022, documented residents were to be provided with a safe, clean, comfortable, and homelike environment. The residents were to have a facility that had pleasant neutral smells, inviting colors and décor, and cleanliness and order. The1/16/2023 facility admission Agreement documented each resident had a locked drawer in their room for storage of personal property. The facility policy Personal Property, revised…

  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 · D2026-05-05 · 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 observations, record review, and interviews, the facility failed to ensure allegations of abuse, neglect, or mistreatment were thoroughly investigated for two (2) of two (2) residents (Residents #267 and #290) reviewed. Specifically, Resident #267 alleged they were sexually abused and Resident #290 alleged they were physically and verbally abused and there was no documented evidence the facility completed a thorough investigation in response to the allegations or reported the allegations to the New York State Department of Health as required. Findings include:The facility policy Resident Rights, last reviewed on 05/28/2024 documented health care personnel shall treat all residents with kindness, respect and dignity. The facility policy Abuse, revised 07/18/2025, documented the facility prohibits the mistreatment, neglect, and abuse of residents/patients and misappropriation of resident/patient property by anyone including but not limited to staff, family, friends and residents of the facility. Definitions of verbal abuse are oral, written or gestured language, that…

  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 · Dcited before2026-05-05 · 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

  Based on observations, record review, and interviews (iQIES Intake 2799654, 2969603, and 2969139) the facility failed to ensure that 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 one (1) of eight (8) residents (Resident #100) reviewed. Specifically Resident #100 was not toileted or changed when they were soiled. Findings include:Resident #100 had diagnoses including hemiplegia (one sided loss of function) following a stroke, depression, and morbid obesity. The 04/13/2026 Minimum Data Set assessment documented the resident had intact cognition, required substantial/maximum assistance with showering, was dependent on toileting and rolling in bed, was frequently incontinent of urine and bowel, was at risk for developing pressure injuries, had unhealed pressure injuries, had three Stage 2 (partial thickness tissue loss) pressure ulcers, and did not reject care.The comprehensive care plan documented:-initiated 04/12/2024 and revised 09/16/2025, the resident had…

  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 before2026-05-05 · 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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review, and interviews (IQIES intakes 2796359 and 2984903), the facility failed to ensure residents received treatment and care in accordance with professional standards of practice for one (1) of one (1) resident (Resident #15) reviewed. Specifically, Resident #15 sustained a fall, was transferred to the hospital, returned to the facility with a fractured clavicle (collarbone), medical was not notified to address the fracture, a sling was not ordered as recommended, and there was no documented evidence the resident received an orthopedic follow up consultation as recommended. Findings include:The facility policy Change in Condition Notification, dated 08/2019, documented it was the facility policy to monitor residents for changes in their condition, to respond appropriately to those changes and to notify the physician and responsible party/family members of changes. The licensed nurse will record in the resident's medical record any significant changes in the resident's condition…

  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

“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.

Fines & penalties

$699,602 in federal fines across 2 penalties. 2 Medicare payment denials on record.

• $378,437 — penalty dated 2024-07-11
• $321,165 — penalty dated 2023-12-05
• Medicare payment denial — starting 2024-08-06 for 50 days
• Medicare payment denial — starting 2024-04-16 for 42 days

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

CMS files one row per role, so the 11 rows in the source record cover these 8 parties — each is shown once here with every role it holds. Nothing is omitted.

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.

About 74% 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 $6.3M paid to related parties — landlords or management companies under common ownership — equal to about 15% of its total expenses. Money routed to affiliated companies can leave a home’s own books looking lean while owners still profit; it is the mechanism regulators watch most closely in private-equity and REIT deals. A reported operating loss is common in this industry and is not by itself a sign of trouble — but paired with large related-party payments it can mean profit is being taken elsewhere in the ownership structure.

Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2023. Facilities self-file these reports; figures are unaudited and a year or two behind. A home with no Medicare cost report on file shows no figures here.

Cost & finances

Straight from this home’s Medicare cost report (CMS, FY2023). These are its operating economics — what it costs to run per resident-day and what it collects on average across Medicare, Medicaid, and private pay — not a private-pay quote. Your out-of-pocket cost depends on payer and room type, so ask the facility directly; a higher operating cost can reflect richer staffing or a sicker population. The cost-of-care planner shows regional benchmarks by care type.

What families pay in NY