Blossom Health Care Center Inc.

Inspectors wroteBased on interview and record review, the facility did not ensure allegations of abuse were responded to timely and in response to allegations of abuse, residents were protected from further potential abuse for one (1) of three (3) residents reviewed (Resident #1). Specifically, on 03/12/2026, Physical Therapy Assistant #1 witnessed an alleged incident involving Resident #1 and Certified Nursing Assistant #1; however, the allegation was not immediately escalated to administration, Certified Nursing Assistant #1 continued to provide resident care across multiple shifts, and the facility did not ensure immediate protective measures were implemented upon initial staff awareness of the allegation.

Inspectors wroteBased on observations and interviews conducted during a Recertification Survey from 09/25/2024 to 10/01/2024, the facility did not ensure that all drugs and biologicals were properly stored in accordance with State and Federal Laws for two of four narcotic (controlled medications) cabinets reviewed. Specifically, numerous controlled medications (drugs that are regulated by law due to their potential for abuse or addiction), including narcotics and opioids (pain relievers), were secured with one lock rather than double-locked per the regulations. This is evidenced by the following: The facility policy Storage of Medications, dated January 2024, included that controlled medications are stored in separately locked, permanently affixed compartments. Access to controlled medication is separate from access to non-controlled medications. [...]

Inspectors wroteBased on observations, interviews, and record review during the Recertification Survey from 09/25/2024 to 10/01/2024, the facility did not ensure there was a policy and procedure regarding use and storage of foods brought to residents by family and other visitors to ensure safe and sanitary storage, handling, and consumption. Specifically, staff were not aware or educated on facility policies and procedures to label, date, and measure temperatures of resident food brought in from outside the facility, and items were not properly labeled and dated.

Inspectors wroteBased on observations and interview during the Recertification Survey from 09/25/2024 to 10/01/2024, for three (first, second, and third floors) of three resident-use floors, the facility did not ensure compliance with all applicable State codes. Specifically, the facility was not in compliance with section 915 of the 2015 edition of the International Fire Code as adopted by New York State, which requires the use of carbon monoxide detection and testing in a building that has fuel-burning appliances.

Inspectors wroteBased on observations, interviews and record reviews conducted during the Recertification Survey 09/25/2024 to 10/01/2024, for one (Resident #29) of four residents reviewed, the facility did not ensure that all alleged violations involving potential abuse, neglect, exploitation, or mistreatment were reported to the New York State Department of Health in accordance with state law. Specifically, the facility did not report an incident to the state agency regarding a care plan violation where Resident #29 fell out of bed while getting care by a staff member sustaining a major injury. This is evidenced by the following: [...]

Inspectors wroteBased on observations, interviews, and record reviews conducted during the Recertification Survey from 09/25/2024 to 10/01/2024, the facility did not ensure all alleged violations involving abuse, neglect, or mistreatment were thoroughly investigated for one (Resident #29) of four residents reviewed. Specifically, the facility did not thoroughly investigate the resident's witnessed fall that resulted in a major injury and a care plan violation. This is evidenced by the following: The facility policy Investigating Resident Injuries, reviewed January 2024, included that all resident injuries are investigated, the director of nursing services or a designee will assess all resident injuries and document findings in the medical record, and descriptions in the medical record must be objective and sufficiently detailed. [...]

Inspectors wroteBased on observations, interviews, and record review conducted during a Recertification Survey and complaint investigation (ACTS Reference number: NY00337359), for one (Resident #53) of two resident's reviewed for pressure ulcers, the facility did not ensure that the resident received the necessary treatment and services consistent with professional standards of practice to promote healing, prevent infection, and prevent new ulcers from developing. Specifically, Resident #53 did not receive treatment for multiple wounds as prescribed by the Physician. This was evidenced by the following: Resident #53 had diagnoses including multiple stage three (full thickness tissue loss involving damage of the subcutaneous tissue) pressure ulcers (left buttock, right buttock, and sacrum), diabetes, and congestive heart failure. [...]

Inspectors wroteBased on observations, interviews, and record reviews conducted during the Recertification Survey from 09/25/2024 to 10/01/2024, for one (Resident #3) of one resident reviewed, the facility did not ensure that residents with limited mobility received the appropriate services, equipment, and assistance to maintain mobility and prevent complications. Specifically, Resident #3 did not consistently receive a hand device (rolled washcloth or gauze pad) for a hand contracture (a shortening of muscles, tendons, and skin) to prevent complications per Occupational Therapy's recommendations and as ordered by the physician. This is evidenced by the following: Resident #3 had diagnoses including cerebral infarction (stroke) with hemiplegia (paralysis on one side of the body) and aphasia (absence or difficulty with speech). [...]

Inspectors wroteBased on observations, interviews, and record reviews conducted during the Recertification Survey 09/25/2024 to 10/01/2024, for one (Resident #29) of three residents reviewed, the facility did not provide specialized care needs for the provision of respiratory care in accordance with professional standard of practice, and the resident's care plan, goals, and preferences. Specifically, Resident #29 was observed wearing oxygen via nasal cannula (a device that delivers oxygen through a person's nose). There was not a physician's order in place for oxygen use or documentation in the Medication Administration and Treatment Administration Records that reflected the use and care of the oxygen. Additionally, the facility did not develop a comprehensive person-centered care plan related to Resident #29's respiratory needs. This is evidenced by the following: [...]

Inspectors wroteBased on observations and interview during the Recertification Survey from 09/25/2024 to 10/01/2024, for two (second and third floors) of three resident-use floors, the facility did not ensure essential equipment was properly maintained in operating condition. Specifically, handwash sinks in soiled utility rooms did not function and were not operational when tested.

Inspectors wroteBased on observations and interviews conducted during the Recertification Survey completed on 12/5/22, it was determined that for three (first, second, and third floors) of three resident use floors, the facility did not provide housekeeping and maintenance services necessary to maintain a safe, clean, comfortable, and homelike environment. Specifically: an exhaust ventilation system was not working, walls were in disrepair or dirty, floors were stained and dirty, resident handwash sinks were stained, privacy curtains were in disrepair or dirty, resident furniture was in disrepair, medical supplies were stored on the floor, a toilet seat was in disrepair, dead insects were present in a light fixture, a resident bed was not functioning properly, and kitchen equipment was not clean.

Inspectors wroteBased on observations, record review, and interview conducted during the Standard Recertification Survey completed on 12/1/22, it was determined that for one (Elevator 1) of two elevators, and two of three laundry dryers the facility did not maintain all mechanical, electrical, and patient care equipment in safe operating condition. Specifically, an elevator serving resident sleeping floors and two resident laundry dryers were out of service, and repairs had not been made.

Inspectors wroteBased on observations and interviews conducted during the Standard Recertification Survey completed on 12/1/22 and complaint investigation (#NY00287526), it was determined that for two (second and third floors) of two resident sleeping floors the facility did not properly maintain the resident nurse call system. Specifically, elements of the nurse call system were not functioning.

Inspectors wroteBased on observation, interview and record review conducted during the Recertification Survey, completed on 12/5/22, it was determined that for one (Resident #13) of eleven residents reviewed for Activities of Daily Living (ADLs), the facility did not ensure that residents received services with reasonable accommodation of resident's needs. Specifically, the resident was not provided a call bell based on the resident's functional needs and preferences. Additionally, the call bell was observed out of the resident's reach on multiple occasions. This is evidenced by the following: The facility policy Answering the Call Light, dated last reviewed and revised January 2022, documented that when the resident is in bed or is confined to a chair be sure the call light is within easy reach of the resident. [...]

Inspectors wroteBased on record reviews and interviews conducted during the Recertification survey, completed 12/5/22, it was determined that for two of (Resident #5 and #28) of 18 residents reviewed, the facility did not ensure that each resident was screened for a mental illness (MI) or intellectual disability (ID) prior to admission to the facility and that individuals identified with MI or ID were evaluated and received care and services in the most integrated setting to meet their needs. Specifically, for Resident #28, there was no evidence that a Pre-admission Screening and Resident Review (PASARR) was completed and for Resident #5, the PASARR was incomplete. Both resident had been admitted to the facility with a significant MI diagnosis. This is evidenced by the following: 1. [...]

Inspectors wroteBased on observations, interviews, and record reviews conducted during the Recertification Survey and complaint investigations (#NY00291558 and #NY00291712), completed on 12/5/22, it was determined that for two (Resident #8 and Resident #26) of three residents reviewed for pressure ulcers, the facility did not ensure the services provided or arranged by the facility as outlined in the Comprehensive Care Plan (CCP) met professional standards of quality. Specifically, there was incomplete documentation that the residents wound care treatments were administered as ordered by the medical team. This is evidenced by the following: 1. Resident #8 had diagnoses that included paraplegia, osteomyelitis (infection in the bones), and mild protein calorie malnutrition. [...]

Inspectors wroteBased on observations, interviews, and record reviews conducted during the Recertification Survey and complaint investigation (#NY00291558, #NY00297274, #NY00287526), completed on 12/5/22, it was determined that for one (Resident #53) of eleven residents reviewed the facility did not ensure that Activities of Daily Living (ADLs) care was provided for dependent residents. Specifically, the resident was not provided incontinence care in a timely manner. Resident #53 had diagnoses including a stroke, chronic pulmonary obstructive disease (COPD) and anxiety. The Minimum Data Set assessment dated [DATE], documented that the resident was moderately impaired cognitively, was always incontinent of bladder (urine) and bowel (stool) and required extensive assistance with personal hygiene. Review of the current Comprehensive Care Plan (CCP) revealed that Resident #53 required assistance with ADLs. [...]

Inspectors wroteBased on observations, interviews and record reviews conducted during the Recertification Survey, completed on 12/5/22, it was determined that for one (Resident #28) of one resident reviewed for vision and hearing, the facility did not ensure that the resident received treatment and/or assistive devices to maintain hearing. Specifically, an audiology (ear) evaluation was not obtained for Resident #28, who was identified to be hard of hearing. This is evidenced by the following: Resident #28 was initially admitted to the facility on [DATE] with diagnoses including schizophrenia, chronic obstructive pulmonary disease (COPD), and anxiety. The Minimum Data Set (MDS) assessment dated [DATE], documented that Resident #28 was moderately impaired of cognitive skills for daily decision making, had adequate hearing ability, was able to understand others and did not have hearing aids. [...]

Inspectors wroteBased on record reviews and interviews conducted during a Recertification Survey and complaint investigation (#NY00297130) completed 12/5/22, it was determined that for one of nine residents reviewed for accidents, the facility did not ensure that the resident's environment remained free from accident hazards as possible. Specifically, the facility transportation vehicle did not have a lap belt resulting in Resident #332 sliding out of the wheelchair and onto the floor of the vehicle during transport. This is evidenced by the following: The undated facility policy: 'Transportation Policy and Procedure' included: Daily checks of vehicle safety measures including but not limited to the following: seat belt checks, lift operation checks, headlight check, hazard light check, wiper check. [...]

Inspectors wroteBased on observations, interviews and record reviews conducted during the Recertification Survey completed on 12/5/22, it was determined that for one of two residents reviewed for feeding tubes, the facility did not provide appropriate treatment and services to prevent complications for a resident with a tube feeding. Specifically, the tube feeding for Resident #34 was not consistently monitored to ensure the accurate amount of daily nutrition via the feeding tube was administered as ordered by the physician. Additionally, the daily amount of free water was not consistently documented to ensure the resident received the adequate amount per physician orders. This is evidenced by: Resident #34 was admitted to the facility on [DATE] with diagnoses including a stroke, adult failure to thrive, dysphagia (difficulty swallowing) and dementia. [...]

Inspectors wroteBased on observations, interviews, and record review conducted during the Recertification Survey completed 12/5/22, for two (2nd floor and 3rd floor) of two units reviewed for Resident Council, the facility did not ensure that residents were informed orally and in writing about their right to file a complaint concerning any suspected violation of state or federal nursing facility regulations, or contact information for State regulatory and local advocacy organizations including but not limited to the State Survey Agency (New York State Department of Health or NYSDOH) and the State Long-Term Care Ombudsman Program. Specifically, neither the contact information for the NYSDOH or the Ombudsman was posted in a place easily accessible to residents. This is evidenced by the following: [...]

Inspectors wroteBased on record review and interviews conducted during the Recertification Survey completed on 12/5/22, it was determined that for two (Resident #5 and #48) of three residents reviewed for hospitalizations, the facility did not ensure that the resident or the resident's representative were notified in writing of the reason for the transfer/discharge to the hospital and in a language that they understand per the regulations. Specifically, Resident #5 and Resident #48 were transferred to the hospital and the facility could not provide evidence that a written notice of transfer/discharge was provided to the resident or the resident's representative. This was evidenced by the following: [...]

Inspectors wroteBased on interviews and record review conducted during the Recertification Survey completed on 12/5/22, it was determined that for two (Resident #5 and #48) of three residents reviewed for hospitalizations, the facility did not ensure a written notification, which specifies the duration of the bed-hold policy, was provided to the resident and/or the resident representative at the time of transfer to the hospital. Specifically, Residents #5 and #48 were transferred to the hospital and the facility could not provide evidence that a written notice of information regarding the facility's bed-hold policy was provided to the residents' or the resident's representatives at the time of transfer or soon after per the regulation. This was evidenced by the following: When requested the facility was unable to provide a policy on bed hold notices. 1. [...]

Inspectors wroteBased on observations and interviews conducted during the Recertification Survey completed on 12/5/22, it was determined that the facility did not ensure that the daily posting of licensed and unlicensed nursing staff was posted in a prominent place readily accessible to residents and visitors per regulation. This was evidenced by: During an observation on 12/1/22 at 9:23 a.m., the nurse staffing sheet was located in a non-resident use hallway (hallway with offices and conference room) behind closed doors. When interviewed on 12/1/22 at 9:23a.m., the staffing coordinator stated that they were not aware that the daily nurse staffing sheet had to be posted in a prominent place. The staffing coordinator stated that after they do rounds in the morning, they print and post the staffing information for the day. [...]

Inspectors wroteBased on observations, interviews and record review conducted during the Recertification Survey, completed on 12/5/22, it was determined that for two (2nd floor and 3rd floor) of two units reviewed for medication storage, the facility did not ensure that an accurate reconciliation of all controlled substances was maintained. Specifically, the narcotic count sheets which included reconciliation of narcotic medications and the signatures of staff members for each shift-to-shift count were not completed to validate the correct controlled substance count. This was evidenced by the following: The facility policy titled Controlled Substance/Narcotic Management Protocol, dated last reviewed and revised in January 2022, documented that all narcotics will be counted and reconciled at the beginning of every shift with the outgoing and oncoming nurse. [...]

Inspectors wroteBased on observations, interviews and record reviews conducted during the Recertification Survey, it was determined that the facility did not establish and maintain an Infection Prevention and Control Program (IPCP) designed to provide a safe, sanitary, comfortable environment and to help prevent the development and transmission of communicable diseases and infections. Specifically, the facility was unable to provide evidence of an IPCP that consistently identified, tracked, investigated, monitored and analyzed surveillance data to prevent infections in the facility. This is evidenced by the following: Review of the facility policy, Infection Control Program, dated 1/29/20, revealed that the facility will establish and maintain an IPCP to help prevent the development and transmission of disease to the extent possible. [...]

Inspectors wroteBased on observations, interviews and record review during the Recertification Survey, it was determined the facility did not ensure the Infection Prevention and Control Program included antibiotic use protocols and a system to monitor antibiotic use. Specifically, the facility did not implement an Antibiotic Stewardship Program. This is evidenced by the following: The facility policy, Infection Control Program, dated 1/29/20, included a general approach to prevention and control of infections including a system for antibiotic review and control to include data reports from the Consultant Pharmacist. Review of the facility policy, Antibiotic Therapy, dated 1/4/19, revealed antibiotic therapy will be prescribed by the medical team as needed and will include fluid monitoring, cultures, indications for use, and pharmacy review. [...]

Inspectors wroteBased on interviews and record reviews during the Recertification Survey, it was determined for two (Residents #14 and #17) of two residents reviewed, the facility did not ensure that each resident was given the right, along with their representative, to participate in the care planning process with their interdisciplinary team members. Specifically, there was no evidence that the residents or their representatives were notified of and provided an opportunity to participate in interdisciplinary care plan meetings. This is evidenced by the following: 1. Resident #14 has diagnoses including diabetes, chronic pain syndrome and neurogenic bowel with colostomy. The Minimum Data Set (MDS) Assessment, dated 10/16/20, revealed the resident was cognitively intact. [...]

Inspectors wroteBased on observations, interviews and record review during the Recertification Survey and Complaint Investigation (#NY00260114), the facility did not ensure that all alleged violations of abuse are thoroughly investigated for two (Residents #6 and #187) of three residents reviewed. Specifically, the facility did not initiate or complete a thorough investigation for allegations of abuse. This evidenced by the following: The facility policy, Abuse, Neglect and Misappropriation, dated as revised 2/8/12, included the facility requires reporting of any potential or actual violations to administration, who will take immediate action to address the incident, and ensure documentation to support the conclusion staff comes to when investigating the incident. 1. Resident #6 had diagnoses including end stage renal disease, diabetes and anxiety. [...]

Inspectors wroteBased on observations, interviews and record reviews conducted during the Recertification Survey for 3 of 23 residents reviewed, the facility did not develop and implement a person-centered Comprehensive Care Plan to meet the resident's medical, nursing, mental, and psychosocial needs and included goals, desired outcomes and preferences. Specifically, Resident #14 did not have compression stockings in place, Resident #18 was not wearing a palm protector on their left hand, and Resident #31 did not have a care plan developed to include interventions related to accident hazards. This is evidenced by the following: 1. Resident #14 had diagnoses including chronic pain syndrome, congestive heart failure and edema. The Minimum Data Set (MDS) Assessment, dated 10/16/20, revealed the resident was cognitively intact and required assistance with dressing. [...]

Inspectors wroteBased on observations, interviews, and record reviews during the Recertification Survey, it was determined that for one (Resident #137) of two residents reviewed, the facility did not provide appropriate treatment and services to prevent potential complications for a resident with a tube feeding (tube inserted directly into the stomach to administer fluid nutrition). Specifically, physician orders were not clarified to ensure accuracy, daily tube feeding amounts were not observed being administered as ordered, and the amount of tube feeding and water flushes were not consistently documented or monitored. This is evidenced by the following: Resident #137 has diagnoses including chronic obstructive pulmonary disease, chronic respiratory failure and shortness of breath. [...]

Inspectors wroteBased on observations, interviews and record reviews during the Recertification Survey, it was determined that for one (Resident #6) of one resident reviewed, the facility did not ensure that residents who require dialysis received services consistent with professional standards of practice. Specifically, there was no evidence that the facility consistently monitored the resident's fluid intake per physician orders. This is evidenced by the following: Resident #6 had diagnoses that included end stage renal disease with hemodialysis, diabetes and anxiety. The Minimum Data Set Assessment, dated 7/28/20, revealed the resident was cognitively intact and received dialysis. [...]

Inspectors wroteBased on observations, interviews and record reviews during the Recertification Survey, it was determined that for one of five residents reviewed, the facility did not ensure that each resident's medication regimen was free from unnecessary medications. Specifically, Resident #9 did not receive any attempts of a gradual dose reduction of an anti-depressant medication within the first year following admission to the facility. This is evidenced by the following: Resident #9 was admitted to the facility on [DATE] with diagnoses including major depressive disorder, single episode, diabetes and congestive heart failure. [...]

Inspectors wroteBased on observations, interviews and record review conducted during the Recertification Survey, it was determined that the facility did not ensure that a qualified dietician carried out the functions of the food and nutrition services. Specifically, the consultant Registered Dietician has not been in the facility since March 2020. Physical nutritional assessments were not completed, and the non-clinical Dietetic Food Supervisor was not provided frequently scheduled consultations. This is evidenced by the following: During interviews on 11/2/20 at 11:27 a.m., 11/4/20 at 2:18 p.m., and 11/5/20 at 11:21 a.m., the Dietetic Service Supervisor said the Registered Dietician works remotely offsite and has not been in the building since the pandemic started in March 2020. She said there has not been any direction or involvement from the Registered Dietician. [...]

Inspectors wroteBased on observations, interviews and record reviews conducted during the Recertification Survey, it was determined that for 8 of 42 residents, the facility did not correctly follow a recipe to prepare modified consistency diets (ground and pureed). Specifically, facility staff did not weigh cooked chicken, prior to grinding or pureeing, to ensure accuracy of portion size and did not follow a recipe for preparation of pureed meat. This is evidenced by the following: The facility policy, Blending of Pureed Food, dated 2020, directs to cook meat according to menu cycle, see daily production sheet for the number of portions needed and weigh the meat. During an observation and interview on 11/4/20 at 10:50 a.m. [...]

Inspectors wroteBased on interviews during the Focused Infection Control Survey and the Recertification Survey, the facility did not designate one or more individuals as the Infection Preventionist who would be responsible for the facility's Infection Prevention and Control Program (IPCP). Specifically, the facility could not provide documented evidence that the designated individuals had completed a specialized training in infection prevention and control. This is evidenced by the following: When interviewed on 11/2/20 at 9:33 a.m., the Administrator stated the Director of Nursing was responsible for the IPCP. In an interview on 11/3/20 at 12:28 p.m. and 11/6/20 at 9:48 a.m., the Director of Nursing (DON) stated that the Infection Preventionist role was shared by the DON and the staff educator. The DON stated that he did not have any specialized training in infection control nor did the staff educator. [...]