Astoria Skilled Nursing and Rehabilitation

Inspectors wroteBased on record review, interview, observation, and review of the facility policy and procedure, the facility failed ensure the smoking policy included information regarding safe smoking areas for independent smokers. This affected two residents (#8 and #53) of three residents (#8, #45, and #53) reviewed for smoking but had the potential to affect seven residents (#4, #8, #22, #23, #25, #30, and #53) the facility identified as independent smokers. The facility census was 68. Findings Include:Review of the medical record for Resident #8 revealed an admission date of 03/26/26. Diagnoses included above the knee amputation of the right leg, chronic obstructive pulmonary disease, and mantle cell lymphoma. [...]

Inspectors wroteBased on observation, interview and review of facility policy, the facility failed to ensure foods were properly stored in the [NAME] Unit kitchenette. This had the potential to affect all 32 residents (#1, #3, #8, #10, #17, #18, #20, #21, #24, #27, #29, #33, #34, #37, #40, #41, #43, #44, #45, #46, #48, #50, #51, #56, #57, #61, #62, #64, #65, #69, #70 and #77) who resided on the [NAME] Unit. The facility census was 67.

Inspectors wroteBased on resident representative interview, medical record review and staff interview, the facility failed to ensure timely notification was provided to a resident representative following an accident. This affected one (Resident #67) of five residents reviewed for accidents. The facility census was 67.

Inspectors wroteBased on medical record review and interview, the facility failed to ensure residents or their representatives were notified in writing of the facility's transfer and bed hold policy for Residents #13, #75, and #76. Additionally, the facility failed to notify the Office of the State Long-Term Care Ombudsman of Residents #75 and #76's transfers to the hospital. This affected three Residents (#13, #75, and #76) of three residents reviewed for hospitalizations. The facility census was 67.

Inspectors wroteBased on medical record review, interviews, and facility policy review, the facility failed to ensure resident were provided the opportunity to participate in care plan meetings. This affected two residents (#3 and #43) of three residents reviewed for care plan meetings. The facility census was 67.

Inspectors wroteBased on medical record review, observation, interview, and facility policy review, the facility failed to ensure a dependent resident received adequate assistance with nail care. This affected one Resident (#62) of three residents reviewed for activities of daily living. The facility census was 67.

Inspectors wroteBased on observation, medical record review and staff interview, the facility failed to ensure admission assessments were completed timely upon admission. This affected one resident (Resident #66) of 26 residents reviewed for assessments. The facility also failed to ensure positioning aide devices were in place as ordered by the physician. This affected one resident (Resident #67) of five residents reviewed for accidents. The facility census was 67.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to provide the necessary treatment to promote healing of a pressure ulcer for one resident (#57) of three residents reviewed for pressure ulcers. The facility identified eight residents with current pressure ulcers at the time of the annual survey. The facility census was 67.

Inspectors wroteBased on medical record review, observation, interview, and facility policy review, the facility failed to maintain safe and responsible smoking practices. This affected two Residents (#13 and #24) of 25 sampled residents. The facility census was 67.

Inspectors wroteBased on medical record review, observation, interview, dialysis contract review, and facility policy review, the facility failed to ensure routine monitoring was completed prior to and following dialysis treatments. Additionally, the facility failed to provide evidence of ongoing communication and collaboration with the dialysis center. This affected one Resident (#3) of one resident reviewed for dialysis treatments. The facility census was 67.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a comprehensive assessment and informed consent were completed prior to implementing bed rails for one resident (#57). The facility census was 67.

Inspectors wroteBased on medical record review and staff interview, the facility failed to ensure residents were not receiving duplicate medication treatment for gastroesophageal reflux disease (GERD). This affected one (Resident #11) of five residents reviewed for medications. The facility census was 67.

Inspectors wroteBased on medical record review, interview, and facility policy review, the facility failed to ensure Resident #43 was free from a significant medication error. This affected one Resident (#43) of five reviewed for unnecessary medications. The facility census was 67.

Inspectors wroteBased on observation, family representative interview, staff interview, and medical record review, the facility failed to maintain complete and accurate medical records. This affected three residents (#2, #57, and #67) of seven residents reviewed for accuracy of records during the annual survey. The facility census was 67.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to maintain effective infection control standards during wound care. This affected one resident (#57) of three residents reviewed for wound care. The facility identified eight current residents with pressure ulcers at the time of the annual survey. The facility census was 67.

Inspectors wroteBased on observation and interview, the facility failed to ensure past survey results were available in a prominent area accessible to residents. This affected twelve residents (#8, #13, #16, #22, #25, #30, #31, #43, #52, #63, #64, and #68) who were in attendance at the Resident Council interview during the annual survey and had the potential to affect all residents of the facility. The facility census was 67.

Inspectors wroteBased on observation and interview, the facility failed to ensure a list of advocacy groups, including contact information, was easily accessible to residents in wheelchairs. This affected nine (#8, #13, #16, #22, #25, #43, #52, #64 and #68) of twelve residents who attended the Resident Council interview and utilized wheelchairs for mobility. The facility identified 47 (#1, #2, #3, #4, #7, #8, #9, #10, #11, #12, #13, #16, #18, #22, # 23, #25, #26, #29, #32, #33, #34, #36, #37, #38, #39, #40, #41, #42, #43, #44, #46, #48, #49, #50, #51, #52, #56, #57, #58, #59, #62, #64, #65, #67, #68, #76 and #77) residents who utilized wheelchairs for mobility. The facility census was 67.

Inspectors wroteTHE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NONCOMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on closed medical record review, review of a facility investigation, employee file review, manufacturer guideline review, policy review and interview, the facility failed to ensure Resident #100 was transferred safely with a mechanical (Hoyer) sling lift resulting in a fall with major injury. Actual harm occurred on 09/11/25 when Resident #100, who was dependent on two staff members and the use of a mechanical sling lift with transfers, sustained a fall and a right hip fracture when being transferred from his bed to wheelchair with only the assistance of one staff member, Certified Nursing Assistant (CNA) #50 and the Hoyer lift. [...]

Inspectors wroteTHE FOLLOWING SURVEY FINDINGS PERTAINS TO AN INCIDENT OF PAST NONCOMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on medical record review, review of weather information at www.timeanddate.com, review of the police report, review of the facility's Self-Reported Incident (SRI) investigation, resident representative interview, staff interview, and facility policy review, the facility failed to provide adequate interventions and supervision to prevent the elopement of a severely cognitively impaired resident. This resulted in Immediate Jeopardy when Resident #12, who was severely cognitively impaired and high risk for wandering and elopement, exited the facility in the early morning hours on [DATE] and was found by a concerned citizen/Good Samaritan walking in the middle of the road approximately 0.55 miles away from the facility. [...]

Inspectors wroteBased on medical record review, policy review, and interview, the facility failed to ensure dressing changes for a resident's peripherally inserted central catheter (PICC) line was changed on a routine ongoing basis. This affected one (Resident #6) of two residents reviewed for care of a PICC line.

Inspectors wroteBased on closed record review, review of hospital records, facility policy and procedure review and interview, the facility failed to timely identify a change in Resident #60's respiratory condition to ensure the resident was provided timely and adequate care. This affected one resident (#60) of three residents reviewed for death. Actual harm occurred beginning on [DATE] when the facility failed to adequately and timely treat respiratory complications exhibited by Resident #60, who was a Full Code (advance directives), non-verbal and had a tracheostomy, which included labored breathing, the resident testing positive for Coronavirus (COVID-19) and being treated with an antibiotic for pneumonia. [...]

Inspectors wroteBased on observations and interview with staff, the facility failed to maintain a clean sanitary kitchen area. This affected all residents in the facility except for the three residents (#5, #6, and #58) who did not receive food from the kitchen. The facility census was 60.

Inspectors wroteBased on review of the closed medical record, interviews, and review of facility policies and procedures, the facility failed to ensure the physician was notified of a change in condition for Resident #60. This affected one resident (Resident #60) of three reviewed for change in condition.

Inspectors wroteBased on observation and interview with residents and staff, the facility failed to ensure the linens were free from stains. This affected one resident (Resident #39) and had the potential to affect all the residents in the facility who utilized the facility linens. The facility census was 60.

Inspectors wroteBased on review of the medical record and interview with staff the facility failed to ensure transportation was set up for a postoperative appointment for Resident #52. This affected one resident (#52) of three reviewed for appointments.

Inspectors wroteBased on review of the medical record, interview, and review of facility policy, the facility failed to implement individualized and effective pressure ulcer interventions timely. This affected one resident (Resident #42) out of three reviewed for pressure ulcers.

Inspectors wroteBased on review of the medical record and interview with staff the facility failed to set up a dental appointment as ordered for Resident #39. This affected one resident (#39) of three reviewed for appointments.

Inspectors wroteBased on review of the medical record, observation, interview with staff, and review of facility policy, the facility failed to maintain appropriate infection control measures during incontinence care for Resident #41. This affected one resident (Resident #41) of three reviewed for incontinence care.

Inspectors wroteBased on observation, record review, interview, and manufacturer guidance review the facility failed to ensure distilled water was replaced as required to prevent infection associated with respiratory therapy tasks and equipment. This affected one out of one resident reviewed for the use of bilevel positive airway pressure (BiPAP) (A mechanical breathing device with a mask that is used to treat sleep apnea and other health conditions that affect breathing.). The facility census was 63.

Inspectors wroteBased on observation, record review, interview, and policy review the facility failed to ensure a medication error rate of less than five percent. Two errors were made within 25 opportunities for error resulting in a medication error rate of eight percent. This affected two (Residents #3 and #50) of three residents observed during medication administration. Facility census was 63.

Inspectors wroteBased on observation, interview, policy review and Center for Disease Control guidance for hand hygiene, the facility failed to ensure staff performed hand hygiene to prevent cross contamination of germs during Resident #3's and Resident #31's medication administration and failed to ensure staff disinfected the glucometer prior to obtaining Resident #3's and Resident #31's blood sugar. This affected two out of three residents observed for medication administration. The facility census was 63.

Inspectors wroteBased on record review and interview, the facility failed to ensure Resident #54's medications were administered as ordered. This affected one (Resident #54) of four residents reviewed for medications. The facility census was 57.

Inspectors wroteBased on medical record review, interviews with staff and family, review of facility investigative information and review of the facility policies titled Abuse, Neglect, Exploitation or Misappropriation-Reporting and Investigating, and Abuse, Neglect, Exploitation and Misappropriation Prevention Program the facility failed to ensure all residents were free from incidents of resident-to-resident sexual abuse. This resulted in Immediate Jeopardy and the potential for actual physical and psychosocial harm beginning on 03/26/24 at approximately 3:00 P.M. when Resident #61 (a female resident), who was severely cognitively impaired was found naked in the facility spa room with Resident #4 (a male resident), who was dressed. On 03/26/24 at approximately 8:00 P.M. State Tested Nursing Assistant (STNA) #505 again found Resident #61 in the spa room with Resident #4. [...]

Inspectors wroteBased on closed medical record review, interviews with staff and family, review of a local Fire Department Patient Care Record, review of hospital records, review of facility investigation information, and review of facility policy and procedures, the facility failed to ensure all residents received adequate and timely care and treatment to meet their total care needs. This resulted in Immediate Jeopardy and subsequent actual harm/death beginning at 05/27/24 at approximately 4:30 A.M. [...]

Inspectors wroteBased on observation, record review and interview the facility failed to maintain sufficient levels of staff to meet the total care needs of all residents. This affected one resident ( Resident #42) of three reviewed for staffing however it had the potential to affect all 60 residents residing in the facility.

Inspectors wroteBased on observations, interview and record review, the facility failed to ensure the kitchen was clean and sanitary. This had the potential to affect 58 residents that received meals from the facility. Two residents (Resident #3 and #5) were identified as receiving nothing by mouth. The facility census was 60.

Inspectors wroteBased on review of the medical record, review of the facility's investigation, interviews with staff and family, and review of facility policy, the facility failed implement their abuse policy to thoroughly investigate and report all allegations of resident-to-resident abuse. This affected two residents (#51, and #61) of five reviewed for abuse. The facility census was 60. Findings Include: 1. Review of Resident #61's closed medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including anemia, history of falling, hypertension, hearing loss, dysthymic disorder, protein-calorie malnutrition, dementia, Alzheimer's disease, depression, and anxiety. The resident was discharged to another facility on 04/05/24 at the request of her family. [...]

Inspectors wroteBased on record review, interview, and review of the facility policy, the facility failed to ensure an allegation of sexual abuse was reported to the State Agency. This affected two resident (Resident #51, and #61) of five reviewed for abuse. The facility census was 60.

Inspectors wroteBased on review of the medical record, review of the facility's investigation, interviews with staff and family, and review of facility policy, the facility failed to thoroughly investigate all allegations of resident-to-resident sexual abuse. This affected two residents (#51, and #61) of five reviewed for abuse. The facility census was 60. Findings Include: 1. Review of Resident #61's closed medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including anemia, history of falling, hypertension, hearing loss, dysthymic disorder, protein-calorie malnutrition, dementia, Alzheimer's disease, depression, and anxiety. The resident was discharged to another facility on 04/05/24 at the request of her family. Review of the admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #61 had severely impaired cognition. [...]

Inspectors wroteBased on review of the medical record and staff interviews, the facility failed to ensure Resident #63 had an adequate supply of narcotic medications to ensure a safe discharge until her post-discharge physician appointment. This affected one resident (Resident #63) of three residents reviewed for safe discharge.

Inspectors wroteBased on review of Notice of Medicare Non-Coverage letters and staff interview, the facility failed to inform the residents of the appeal agency and their phone number. This affected five (Resident #22, Resident #28, Resident #29, Resident #49, and Resident #62) of five residents reviewed for liability notices. The census was 61.

Inspectors wroteBased on record review and interview, the facility failed to ensure there was a full-time dietary manager to oversee daily kitchen operations. This had the potential to affect all 58 residents (except Residents #9, #54 and #212) who received food from the kitchen. The facility census was 61.

Inspectors wroteBased on observation, interview, and review of the dietary schedules, the facility failed to ensure there was sufficient competent staff to work in the kitchen. This had the potential to affect all 58 residents (except Residents #9, #54, and #212) who received food from the kitchen. The facility census was 61.

Inspectors wroteBased on record review, observation, interview, and review of facility policy, the facility failed to store foods in a manner to prevent contamination, monitor sanitizer solution concentration, monitor dishwasher temperatures, and ensure staff working in the kitchen had their hair secured and covered. This had the potential to affect all 58 residents (except Residents #9, #54, and #212) who received food from the kitchen. The facility census was 61.

Inspectors wroteBased on observation and interview, the facility to provide a dignified dining experience for residents. This affected three residents (#8, #19, and #38) observed during meals in the dining room. The facility census was 61.

Inspectors wroteBased on interview and record review the facility failed to provide timely notification to the state ombudsman of 30 day discharges for Resident #33 and Resident #41. This affected two residents of four reviewed for discharge notices. The facility census was 61.

Inspectors wroteBased on record review and interview, the facility failed to ensure Resident #56 was provided adequate supervision to prevent an attempted elopement, and failed to investigate a fall and re-assess the resident to determine if current fall interventions remained appropriate to prevent future falls. This affected one (Resident #56) of five residents reviewed for accidents and hazards.

Inspectors wroteBased on observation, review of the medical record and interview with the staff and resident, the facility failed to ensure Resident #5 had his fingernails trimmed and Resident #8 was shaved. This affected two residents ( Resident #5 and #8) of 12 residents who required assistance by staff for activities of daily living (ADLS). The facility census was 61.

Inspectors wroteBased on observation, record review, facility policy review and interview the facility failed to ensure fall interventions were in place for Resident #40 as ordered/care planned. This affected one resident (#40) of three residents reviewed for fall interventions.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure call lights were within reach and accessible for Resident #20 and Resident #53. This affected two residents (#20 and #53) observed during random observations. The facility census was 66.

Inspectors wroteBased on observation, staff interview and facility policy the facility failed to ensure medication delivered from the pharmacy were locked in a secure location. This affected three residents (Resident #52, #319, and #468) who were cognitively impaired and independently mobile in the facility. The facility census was 70.

Inspectors wroteBased on observation, staff interview and record review, the facility failed to ensure transmission-based precautions were implemented for four of seven residents (Resident #471, #472, #473 and #475) in the facility that were presumed Covid-19 positive and infection control signs were not posted outside of all isolation rooms. The facility had no positive Covid-19 residents. The census was 70. Finding Include: 1. Review of the medical record for Resident #471 revealed an admission date on 03/11/22. Review of the orders revealed droplet isolation orders per admission protocol for 10 days. Observation on 03/14/2022 at 8:06 A.M. of License Practical Nurse (LPN) #512 revealed LPN #512 entered Resident #471 to deliver breakfast tray, Resident #471 was on droplet precautions for new admission. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure residents or resident representatives received a written copy of the Notice of Medicare Non-Coverage (NOMNC) and Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNF ABN). This affected two (Residents #22 and #38) of four residents reviewed for beneficiary protection notification. The facility census was 70.

Inspectors wroteBased on observation and staff interview the facility failed to trim and clean the fingernails for Resident #49 and failed to provide routine hand hygiene for Resident #46, both who required staff assistance for activities of daily living. This affected two residents (Resident #46 and #49) of three reviewed for activities of daily living.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to implement supervision and smoking interventions for Resident #12 to smoke safely. This affected one of five residents identified as smokers in the facility (#6, #32, #47 and #56). The facility census was 70.