Apex Rehabilitation & Care Center

Inspectors wroteBased on observations, record review, and interviews conducted during the Recertification survey initiated on 4/8/2025 and completed on 4/16/2025, the facility did not follow proper sanitation practices to prevent the outbreak of foodborne illness and did not store and prepare food in accordance with professional standards for food service safety. This was identified during the Kitchen Task. Specifically, during the kitchen observation on 4/8/2025, the final rinse cycle temperature of the high-temperature dishmachine was observed to be below 180 degrees Fahrenheit. The dietary staff did not operate and monitor the dishmachine temperatures for the rinse cycle as per the manufacturer's recommendation to ensure proper sanitization of the dishes. The finding is: [...]

Inspectors wroteBased on observations, record review, and interviews during the Recertification Survey initiated on 4/8/2025 and completed on 4/16/2025, the facility did not ensure that each resident received care, consistent with professional standards of practice, to prevent Pressure Ulcers. This was identified for two (Resident #152 and Resident #132) of four residents reviewed for Pressure Ulcers. Specifically, 1) Resident #152 with multiple pressure ulcers utilized an air mattress as a care plan intervention. During multiple observations, the adjustable weight setting for the air mattress, which is meant to correspond to the resident's weight, was not set accurately. 2) Resident #132 utilized an air mattress according to their plan of care. During observation, the air mattress weight setting was set at 300 pounds while the resident weighed 85 pounds.

Inspectors wroteBased on record review and interviews during the Recertification Survey and Abbreviated Survey (Complaint # NY 00359457) initiated on 4/8/2025 and completed on 4/16/2025, 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 of each resident. Specifically, facility administration did not ensure Medication/Treatment Nurse #1, Medication/Treatment Nurse #2, Medication/Treatment Nurse #3, Medication/Treatment Nurse #4, and Medication/Treatment Nurse #6 had approved limited permit or a current New York State Registered Nurse license to work at a health care facility as Registered Nurses. Cross Reference: F839 Administration-Staff Qualifications The finding is: [...]

Inspectors wroteBased on record review and interviews during the Recertification Survey and Abbreviated Survey (Complaint# NY 00359457) initiated on [DATE] and completed on [DATE], the facility did not ensure professional staff were licensed, certified, or registered in accordance with applicable State laws. This was identified for five (Medication/Treatment Nurse #1, Medication/Treatment Nurse #2, Medication/Treatment Nurse #3, Medication/Treatment Nurse #4, and Medication/Treatment Nurse #6) of six employees reviewed for Licensure and Certification. Specifically, Medication/Treatment Nurse #1, Medication/Treatment Nurse #2, Medication/Treatment Nurse #3, Medication/Treatment Nurse #4, and Medication/Treatment Nurse #6 were working as Registered Nurses at the facility; [...]

Inspectors wroteBased on observations, record review, and interviews during the Recertification Survey initiated on 4/8/2025 and completed on 4/16/2025, the facility did not ensure that each resident was treated with respect and dignity and in a manner and in an environment that promotes maintenance or enhancement of their quality of life. This was identified for one (Resident #136) of one resident reviewed for Dignity. Specifically, on 4/8/2025, during multiple observations, Resident #136 was observed from the hallway with a Foley Catheter drainage bag half filled with yellow-colored fluid (urine). The drainage bag was not covered with a privacy bag. Additionally, Resident #35's Jackson Pratt (defined as a surgical suction drain that gently draws fluids from a wound after surgery) drain bulb containing yellowish-orange drainage was also visible from the hallway without any privacy covering. [...]

Inspectors wroteBased on record review, and interviews during the Recertification and abbreviated complaint (NY 00349884) survey initiated on 4/8/2025 and completed on 4/16/2025, the facility did not ensure that all alleged violations involving abuse, neglect, exploitation, or mistreatment, including injuries of unknown source were reported immediately to the facility administration and were reported to the Department of Health within 24 hours. This was identified for two (Resident #6 and Resident #34) of two residents reviewed for abuse and for one (Resident #29) of one resident reviewed for Skin Conditions. Specifically, 1) a resident to resident altercation between Resident #34 and Resident #6 that resulted in a scratch to Resident #34's right arm and Resident #6's fall was not reported to the New York State Department of Health timely. [...]

Inspectors wroteBased on record review and staff interviews during the Recertification Survey initiated on 4/8/2025 and completed on 4/16/2025, the facility did not have evidence that all alleged violations of abuse, neglect, and mistreatment were thoroughly investigated. This was identified for one (Resident #51) of two residents reviewed for Hospitalization. Specifically, Resident #51 with a recent history of left hip replacement and was dependent on staff assistance for Activities of Daily Living, was found in their room with their left hip internally rotated (rotated inward) with leg discrepancy (one leg was shorter than the other). The facility did not obtain statements from all employees involved with resident care to determine the root cause of the incident. The finding is: [...]

Inspectors wroteBased on observations, record review, and staff interviews during the Recertification Survey initiated on 4/8/2025 and completed on 4/16/2025, the facility did not ensure that a resident received treatment and care in accordance with professional standards of practice. This was identified for one (Resident #136) of three residents reviewed for Catheter care. Specifically, Resident #136 had a Physician's Order to monitor and document the Jackson Pratt (a closed-suction medical device used after surgery to drain fluids from a wound or incision) drain and to keep the drain bulb at negative pressure (achieved by compressing the bulb to gently pull fluids from the surgical site). During multiple observations, Resident #136's Jackson Pratt drain bulb was not compressed, which indicated that the Jackson Pratt drain was not at negative pressure. [...]

Inspectors wroteBased on observation, record review, and staff interviews during the Recertification Survey initiated on 4/8/2025 and completed on 4/16/2025, the facility did not ensure that each resident's environment remained free of accidents. This was identified for one (Resident #32) of five residents reviewed for Accidents. Specifically, Resident #32 resided in a unit that had three residents (Resident #24, Resident #77, and Resident #101) with wandering behaviors. During observation, one 16-ounce bottle of nail polish remover, three disinfectant spray bottles, and four air freshener spray bottles were observed in Resident #32's room on their nightstand. The finding is: The facility's undated policy, titled Accidents and Hazards, defined Hazards as elements of the resident environment that have the potential to cause injury or illness. [...]

Inspectors wroteBased on observation, record review, and interviews during the Recertification Survey initiated on 4/8/2025 and completed on 4/16/2025, the facility did not assist each resident in making an appointment for necessary dental services. This was identified for one (Resident #39) of one resident reviewed for Dental Services. Specifically, Resident #39 had an annual dental consult completed on 2/26/2025. The Dentist documented resident had broken teeth and recommended referral to an outside oral surgeon for full mouth extraction. There was no documented evidence that the recommendations made by the Dentist were addressed by the facility until 4/15/2025 after the Surveyor brought the concern to the facility's attention. The finding is: [...]

Inspectors wroteBased on record review and staff interviews during the Recertification Survey initiated on 4/8/2025 and completed on 4/16/2025, in accordance with accepted professional standards and practices, the facility did not maintain medical records on each resident that were complete. This was identified for one (Resident #151) of one resident reviewed for Dialysis. Specifically, there was no documented evidence in the treatment administration record that Resident #151's right chest Permacath (a long-term catheter used for dialysis treatment) was monitored every shift for signs and symptoms of bleeding, placement, and skin integrity. The finding is: [...]

Inspectors wroteBased on observations, record review, and interviews during the Recertification Survey initiated on 4/8/2025 and completed on 4/16/2025, the facility did not ensure it established an infection prevention and control program designed to help prevent the development and transmission of communicable diseases and infections for one (Resident #321) of one resident reviewed for Transmission-Based Precautions and for one (Resident #43) of five residents observed during the Medication Administration Task. Specifically, 1) Resident #321 had a Physician's order for Contact Precautions for Shingles (a rash caused by the virus that causes Chickenpox) with an antiviral medication; however, there was no Contact Precautions signage posted in a conspicuous location outside the resident's room that instructs staff and visitors for use of specific Personal Protective Equipment. [...]

Inspectors wroteBased on observations, record reviews and interviews conducted during a complaint investigation, Complaint # NY00313313 initiated on 2/21/2024 and completed on 2/27/2024, the facility did not ensure that pain management was provided, consistent with professional standards of practice, the comprehensive persons-centered care plan, and the resident's goal and preferences. This was identified for one (Resident #1) of three residents reviewed for pain management. Specifically Resident #1 suffered pain following a fall, rating it at a level of 10 out of 10 (0 indicating no pain 10 indicating most severe). Resident #1 had an physician's order for pain medication to address moderate to severe pain, the nurse did not administer the medication nor notify the doctor of the resident's new pain after the fall. [...]

Inspectors wroteBased on observations, records review, and interviews during Recertification Survey and Abbreviated Survey (NY 00319371) initiated on 2/6/2024 and completed on 2/14/2024, the facility did not ensure that a clean, comfortable, and homelike environment was maintained for each resident. This was identified for four (Resident #146, Resident #85, Resident #104, and Resident #93) of four residents reviewed for Environment. Specifically, 1) Resident #146's room was observed on 2/6/2024 and 2/7/2024; the room furniture and the sink vanity were not in good repair with detached base molding, missing drawers, and rusty exposed metal parts. 2) Resident #85's room was observed on 2/6/2024 and 2/7/2024. The room furniture and the sink vanity were not in good repair with missing drawers and a nonfunctioning bureau. 3) Resident #104's room was observed on 2/6/2024 and 2/7/2024. [...]

Inspectors wroteBased on observations, record review and interviews conducted during a Recertification and abbreviated Survey (NY 00318188) initiated on 2/6/2024 and completed on 2/14/2024, the facility did not ensure that the residents' environment remained as free from accident hazards as possible, and each resident receives adequate supervision to prevent accidents. This was identified for one (Resident #146) of 11 residents reviewed for Accidents/elopement, 2) for six (Resident #93, Resident #104, Resident #146, Resident #103, Resident #112, and Resident #85) of eleven residents reviewed for Accidents hazards; and 3) for one Unit 1A of four units observed during the Medication Storage Task. [...]

Inspectors wroteBased on observations, records review, and interviews during the Recertification Survey initiated on 2/6/2024 and completed on 2/14/2024 the facility did not ensure all drugs and biologicals were stored in locked compartments and permitted only authorized personnel to have access to the keys. This was identified for one unit (Unit 1A) of four units observed during the Medication Storage Task. Specifically, during an observation of the medication storage on 2/14/2024, the medication closet on Unit 1A was observed without a lock. The medication closet door had no locking mechanism installed on the door. The storage closet had multiple medications, syringes, and intravenous medication bags stored. The finding is: [...]

Inspectors wroteBased on record review and interviews during the Recertification Survey initiated on 2/6/2024 and completed on 2/14/2024, the facility did not ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source are reported immediately to the New York State Department of Health, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury. This was Identified for one (Resident #98) of 11 residents reviewed for Accidents. Specifically, on 11/24/2023 Resident #98 was identified with an injury of unknown origin. [...]

Inspectors wroteBased on record review and interviews during the Recertification Survey initiated on 2/6/2024 and completed on 2/14/2024 the facility did not ensure that all incidents including the injury of unknown origin were thoroughly investigated . This was identified for one (Resident #98) of 11 residents reviewed for Accidents. Specifically, on 11/24/2023 at 8:00 AM Resident #98 was observed with an injury of unknown origin and the facility did not thoroughly investigate the incident to identify the root cause of the injury and to rule of Abuse, Neglect, and Mistreatment. The finding is: The facility's policy titled, Accident/Incident last revised December 2023, documented that all injuries of unknown sources will be investigated. [...]

Inspectors wroteBased on record review and interview during the Recertification Survey initiated on 2/6/2024 and completed on 2/14/2024, the facility did not ensure that the Minimum Data Set (MDS) assessment accurately reflects the resident's status. This was identified for one (Resident #61) of one resident reviewed for Dialysis. Specifically, the Minimum Data Set assessment for Resident #61 did not accurately capture that the resident was receiving dialysis treatment. The finding is: The facility policy and procedure titled, MDS 3.0, last reviewed 10/2023, documented that residents are assessed, using a comprehensive assessment process, to identify care needs and to develop an interdisciplinary care plan. Resident #61 was admitted with diagnoses including Cancer, End-Stage Renal Disease (ESRD), and Dependence on Renal Dialysis. [...]

Inspectors wroteBased on observation, record review, and interviews during the Recertification Survey initiated on 2/6/2024 and completed on 2/14/2024 the facility did not ensure a person-centered comprehensive care plan was reviewed and revised to address each resident's needs. This was identified for one (Resident #152) of 35 sampled residents. Specifically, a quarterly Minimum Data Set assessment was completed on 12/20/2023 for Resident #152. There was no documented evidence that a care plan meeting was held after each assessment including both the comprehensive and quarterly review assessments. The resident or their representative were not provided notice of a care plan meeting for an opportunity to attend and participate. [...]

Inspectors wroteBased on observation, record review, and interviews during the Recertification Survey initiated on 2/6/2024 and completed on 2/14/2024 the facility did not ensure that each resident who is unable to carry out activities of daily living received the necessary services to maintain personal hygiene. This was identified for one (Resident #122) of two residents reviewed for Activities of Daily Living. Specifically, on 2/6/2024 Resident #122 was observed with long, dirty, and jagged fingernails with a brown substance under the nails on both hands. The finding is: [...]

Inspectors wroteBased on record review and staff interviews during the Recertification Survey initiated on 2/6/2024 and completed on 2/14/2024, the facility did not ensure sufficient nursing staff were available to provide nursing and related services to ensure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial wellbeing of each resident. This was identified for three (Unit 1A, Unit 2A, and Unit C) of four Units during the Sufficient Staffing Task review. Specifically, a review of the Payroll Based Journal (PBJ) Staffing Data Report, the Facility Assessment, review of weekend staffing and staffing during the Recertification Survey revealed the facility had insufficient nursing staff on numerous occasions. The finding is: [...]

Inspectors wroteBased on observation, record review, and interviews during the Recertification Survey initiated on 2/6/2024 and completed on 2/14/2024 the facility did not ensure that nurse's aides were able to demonstrate competency in skills and techniques necessary to care for residents' needs, as identified through resident assessments, and described in the plan of care. This was identified for one (Resident #48) of two residents reviewed for Choices. Specifically, Certified Nursing Assistant #8 was observed utilizing a sink as a basin to store the water for providing care to Resident #48 in a semi-private room. The sink is also utilized by other residents for handwashing and other hygiene tasks. The finding is: [...]

Inspectors wroteBased on record review and interviews during the Recertification Survey initiated on 2/6/2024 and completed on 2/14/2024 the facility did not ensure each resident received radiology services in a timely manner. This was identified for one (Resident #48) of two residents reviewed for Choices. Specifically, Resident #48 had a Physician's order for pacemaker checks every three months and there was no documented evidence that the pacemaker checks were completed as per the Physician's order since 10/4/2023. The finding is: The facility Pacemaker Policy, last reviewed on 6/2023, documented the charge nurse was responsible for ensuring that pacemaker/automated implantable defibrillator (AICD-a device inserted into the chest to help fix fast, abnormal heart rhythms) checks are conducted and reported in compliance with Physician's orders every 3 to 6 months. [...]

Inspectors wroteBased on observation, record review, and interviews during the Recertification Survey, initiated on 2/6/2024 and completed on 2/14/2024, the facility did not ensure each resident received routine dental services to meet the needs of each resident. This was identified for one (Resident #147) of two residents reviewed for Dental Services. Specifically, Resident #147 was admitted to the facility with full upper and lower dentures. The resident lost the upper dentures while a resident at the facility. A dental consult dated 1/11/2023 documented that a preliminary impression for the lost dentures would take place at the next session. There was no documented evidence that the preliminary impression for the upper dentures was completed. [...]

Inspectors wroteBased on observations, record review, and interviews during the Recertification Survey initiated on 2/6/2024 and completed on 2/14/2024, the facility did not establish and maintain an infection prevention and control program designed to prevent the development and transmission of communicable diseases and infections. This was identified for one (Resident #383) of two residents reviewed for Transmission-Based Precautions, one (Resident #48) of two residents reviewed for Choices, and one (Resident #60) of two residents reviewed for pressure ulcers. Specifically, 1) the facility did not ensure that an employee (Certified Nursing Assistant #3) wore the appropriate Personal Protective Equipment (PPE) in Resident #383's room who was on Contact and Droplet Precautions for COVID-19 infection. [...]

Inspectors wroteBased on observations, record review, and interviews during the Recertification Survey completed on 2/14/2022 the facility failed to ensure an infection prevention and control program to help prevent the development and transmission of communicable diseases and infections was maintained. This was identified for two (Resident #4 and Resident #154) of four residents reviewed for Skin Conditions and one (Resident #53) of three residents reviewed for Pressure Ulcers. Specifically, 1) during the wound care observation of Resident #4's right lateral leg wound, right heel, and plantar foot wounds the Registered Nurse (RN) #6 did not perform hand hygiene and did not change gloves after cleaning the leg wounds. Additionally, after cleaning the heel and plantar wounds, RN #6 allowed the wounds to come in contact with a dirty surface. [...]

Inspectors wroteBased on observation, record review, and interviews during the Recertification Survey completed on 2/14/2022, the facility did not ensure that a comprehensive person- centered care plan (CCP) was developed to meet the resident's medical and nursing needs to include the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being. This was identified for one (Resident #222) of three residents reviewed for Pressure Ulcers. Specifically, Resident #222 who had a Stage 3 Pressure Ulcer to the sacral area upon admission and was identified as requiring two person staff assistance for bed mobility. The resident's CCP did not have specific interventions to address turning and positioning needs. The finding is: [...]

Inspectors wroteBased on observation, record review, and interviews during the Recertification Survey completed on 2/14/2022, the facility did not ensure that each resident received care and treatment in accordance with professional standards of practice and the comprehensive person-centered care plan. This was identified for one (Resident #4) of four residents reviewed for skin conditions. Specifically, during the observation of Resident #4's right plantar foot wound care the Registered Nurse (RN) #6 did not pack the wound with the Iodoform wound packing as per the Physician's order. The finding is: The facility's policy titled, Wound Treatment Administration, last reviewed 1/2022, documented to provide evidenced-based treatments in accordance with current standards of practice and physician's orders. [...]

Inspectors wroteBased on observation, record review, and interviews during the Recertification Survey completed on 2/14/2022, the facility did not ensure that all resident's environment was free from accident hazards. This was identified for one (Resident #152) of eight residents reviewed for Accidents. Specifically, Resident #152, who was ambulatory, was not moved out of their room while there were repairs being made for an active leak. Staff did not ensure that signage indicating the wet floor was in place to alert the resident of the wet floor. The finding is: The Accident/Incident facility policy dated 1/2022 documented that it is the policy of the facility to maintain the safety of all residents. In compliance with the New York State Department of Health regulation, the resident environment remains free of accident hazards. [...]

Inspectors wroteBased on observations, record review, and staff interviews during the Recertification Survey completed 2/14/2022, the facility did not ensure that each resident who needs respiratory care was provided such care, consistent with professional standards of practice, for one (Resident #17) of two residents reviewed for Respiratory Care. Specifically, Resident #17 was observed receiving oxygen therapy without a physician's order. The finding is: The facility's policy titled Oxygen Administration, last reviewed in January 2022, documented oxygen administration shall be initiated under orders of a physician or physician-extender, except in the case of an acute need. In such cases, oxygen is administered and orders for oxygen are obtained as soon as is able. Resident #17 was admitted to the facility with diagnoses including Heart Failure, Chronic Obstructive Pulmonary Disease, and Hypoxemia. [...]