Alpine Rehabilitation and Nursing Center

Inspectors wroteBased on observations, record review, and interviews, 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 two (2) of three (3) residents (Residents #24 and #64) reviewed. Specifically, Resident #64 was admitted to the facility with pressure ulcers and pressure relief measures were not implemented timely; Resident #24 was identified as high risk for the development of pressure ulcers and did not have adequate pressure relief measures in place and subsequently developed a pressure ulcer on their heel.

Inspectors wroteBased on observation, record review, and interviews during a survey, the facility failed to ensure resident menus were followed for one (1) of one (1) meal preparations observed. Specifically, the facility ran out of preplanned barbeque chicken thighs and did not follow the recipe of the preplanned cheddar broccoli bake.

Inspectors wroteBased on observations, record review, and interviews (iQIES intake 2809584), the facility failed to 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 two (2) of two (2) residents (Residents #13 and #48) reviewed. Specifically, Resident #13 did not have a significant bowel movement from 07/25/2025-08/08/2025 and there was no documented evidence bowel interventions were consistently provided, the resident's gastrointestinal status was assessed, or the physician was notified; and Resident #48 had position changing alarms initiated, impacting the resident's freedom of movement, without trialing other interventions first.

Inspectors wroteBased on observation, record review, and interviews the facility failed to ensure the correct medication was administered in the correct dose in accordance with manufacturer's specifications and with standards of practice for of one (1) of six (6) residents (Resident #2) reviewed. Specifically, Resident #2's insulin pen was not primed (removal of air bubbles to ensure the precise dosage of insulin) prior to administration.

Inspectors wroteBased on record review, observation, and interview during the recertification and abbreviated (NY00309906 and NY00338730) surveys conducted 4/29/2024-5/3/2024, the facility did not ensure residents had the right to a safe, clean, comfortable, and homelike environment for 2 of 2 resident units (north and south units) reviewed. Specifically, the South Unit hallways and common areas smelled of urine and had sticky floors; there was a stained ceiling tile on the South Unit; resident room [ROOM NUMBER] had sticky floors and strips of missing paint; resident room [ROOM NUMBER] had strips of missing paint; the South unit shower room had tiles missing around the drain; the floor in resident room [ROOM NUMBER] was unclean and sticky; resident rooms [ROOM NUMBERS] were cluttered with refuse; and resident rooms [ROOM NUMBERS] smelled of urine.

Inspectors wroteBased on observation and interview during the recertification survey conducted 4/29/2024-5/3/2024, the facility did not ensure drugs and biologicals were labeled and stored in accordance with currently accepted professional principles and included expiration dates when applicable for 1 of 2 medication refrigerators (North Unit), 1of 4 medication carts (North Unit), and 1 of 2 treatment carts (North Unit) reviewed. Specifically, the North Unit medication and treatment carts were unlocked and unattended; and there was an open vial of Purified Protein Derivative (used to diagnose tuberculosis) solution in the North Unit refrigerator that was not labeled with an opened date.

Inspectors wroteBased on observation and interview during the recertification survey conducted 4/29/2024-5/3/2024, the facility did not ensure food was stored, prepared, distributed, and served in accordance with professional standards for food service safety in the main kitchen. Specifically, the main kitchen had outdated and undated food, an unclean stove/oven/flattop cooking area, an unclean walk-in freezer, a leaking dish machine, missing tiles at the bottom of the handwash sink, an unsecured wall covering, and a plate warmer cord that was in disrepair.

Inspectors wroteBased on observation, record review, and interview during the recertification survey conducted 4/29/2024-5/3/2024, the facility did not maintain an effective pest control program so that the facility was free of pests for 2 of 2 nursing units (North and South Units) and the main kitchen. Specifically, there was evidence of ants and house flies on the South Unit, and fruit flies on the North Unit and in the main kitchen.

Inspectors wroteBased on record review and interview during the recertification and abbreviated survey conducted 4/29/2024-5/3/2024, the facility did not provide the appropriate liability and appeal notices to Medicare beneficiaries for 2 of 3 residents (Residents #71 and #233) reviewed. Specifically, Resident #71 remained in the facility after discontinuation of Medicare Part A services and the facility did not provide the resident with a Skilled Nursing Facility Advanced Beneficiary Notice of Non-Coverage (Centers for Medicare and Medicaid Services-10055) for Medicare Part A as required; and Resident #233 was discharged home and the facility did not provide the resident with a Notice of Medicare Non-Coverage (Centers for Medicare and Medicaid Services-10123) for Medicare Part A as required.

Inspectors wroteBased on record review and interview during the recertification and abbreviated (NY00333325) surveys conducted 4/29/2024-5/3/2024, the facility did not ensure all alleged violations involving abuse, neglect, or mistreatment were thoroughly investigated for 1 of 1 resident (Resident #37) reviewed. Specifically, Resident #37 eloped (exited the facility without being detected) out of an egress door, and the incident was not thoroughly investigated.

Inspectors wroteBased on observations, record review, and interviews during the recertification and abbreviated (NY00309906) surveys conducted [DATE]-[DATE], 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 1 resident (Resident #70) reviewed. Specifically, Resident #70 was not provided anti-nausea medications when needed. Additionally, there was emesis (vomit), feces, and a full urine bag visible at the resident's bedside.

Inspectors wroteBased on observation, record review, and interview during the recertification surveys conducted 4/29/2024-5/3/2024, the facility did not ensure that residents were free of any significant medication errors for 1 of 1 resident (Resident #5) reviewed. Specifically, Resident #5 was administered Humalog insulin (fast-acting insulin, starts working approximately 15 minutes after injection to lower blood glucose levels) and was not served their meal timely.

Inspectors wroteBased on observation and interview during the recertification and abbreviated (NY00309906 and NY00338730) surveys conducted 4/29/2024-5/3/2024, the facility did not ensure each resident received food and drink that was palatable, flavorful, and appetizing for 1 of 2 test trays (4/29/2024 lunch meal) reviewed. Specifically, the lasagna served at the 4/29/2024 lunch meal was burnt; and 7 of 7 anonymous residents at the Resident Council meeting complained of food not being flavorful and not being served at palatable and appetizing temperatures.

Inspectors wroteBased on observation, record review, and interviews during the recertification survey conducted 4/29/2024-5/3/2024, the facility did not 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 licensed practical nurses (licensed practical nurse #7) observed during medication administration. Specifically, licensed practical nurse # 7 did not perform hand hygiene after removing their gloves during medication administration.

Inspectors wroteBased on observation, interview and record review during the recertification survey conducted 2/22/22-2/28/22, the facility failed to store and label drugs and biologicals in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration dates when applicable for 2 of 4 medication carts and 2 of 2 medication storage rooms reviewed. Specifically, the North medication cart had resident-specific medications that were not labeled, discharged resident medications were in a bag labelled with a current resident's name, and staff drinks were stored in the bottom drawer of the medication cart. The South medication cart had unlabeled and expired vials of insulin, and house stock medications requiring refrigeration were on the cart. [...]

Inspectors wroteBased on observation, record review and interview during the recertification survey conducted 2/22/22- 2/28/22, the facility failed to ensure the right to self-administer medications if the interdisciplinary team has determined that this practice is clinically appropriate for 1 of 1 resident (Resident # 19) reviewed. Specifically, Resident #19 had Diclofenac gel (a nonsteroidal anti-inflammatory topical medication) at their bedside and there was no documented evidence the interdisciplinary team had assessed the resident's ability to safely self-administer the medication.

Inspectors wroteBased on record review and interview during the recertification survey conducted 2/22/22-2/28/22 the facility failed to provide the appropriate liability and appeal notices to Medicare beneficiaries for 3 of 3 residents (Residents #222, 223 and 224) reviewed. Specifically, Residents #222, 223 and 224 were discharged to home and the facility did not provide the residents with Notice of Medicare Non-Coverage (NOMNC) CMS-10123 (Centers for Medicare and Medicaid Services) for Medicare Part A as required.

Inspectors wroteBased on observation, record review, and interview during the recertification survey conducted 2/22/22-2/28/22, the facility failed to ensure that a resident who needs respiratory care is provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 1 of 1 resident (resident #275) reviewed. Specifically, Resident #275 was administered oxygen without a medical order.

Inspectors wroteBased on observation and interview during the recertification and abbreviated surveys (NY00253216) conducted 2/22/22-2/28/22 the facility failed to post on a daily basis at the beginning of each shift, the current resident census and the total number and the actual hours worked by licensed and unlicensed nursing staff directly responsible for resident care per shift, in a prominent location readily accessible to residents and visitors for 4 of 4 days reviewed. Specifically, the current daily resident census and nurse staffing schedules were posted in the administrative hall on a wall near the staff time clock in a dimly lit area that was not readily accessible to residents and visitors.

Inspectors wroteBased on observation, record review, and interview during the recertification and abbreviated (NY00253216) surveys, conducted 2/22/22-2/28/22, the facility failed to ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences for 2 of 9 residents (Residents #55 and 58) reviewed. Specifically, Resident #58 was not provided their food preferences for 3 meals and Resident #55 received a brown, mushy banana and preferred a fresh banana.

Inspectors wroteBased on observation, interview, and record review during the recertification survey conducted 2/22/22-2/28/22, the facility failed to store, prepare, distribute food in accordance with professional standards for food service safety in one isolated area (main kitchen). Specifically, the kitchen exhaust hood, microwave, wall mounted fan, and floors were soiled, dust laden and unclean.