Brookhaven Nursing and Rehabilitation Center

Inspectors wroteBased on observations, interviews, and record review the facility failed to establish and 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 (Resident #10) of 6 residents, reviewed for infection control. 1. LVN A failed to don PPE prior to performing the high contact resident care activity on a resident who was on enhanced barrier precaution. This failure placed residents at risk for healthcare associated cross contamination and infections.

Inspectors wroteBased on interviews and record review, the facility failed to coordinate assessments with the pre-admission screening and resident review (PASARR) program under Medicaid in subpart C to the maximum extent practicable to avoid duplicative testing and effort for 1 (Resident #1) of 3 residents reviewed for PASARR services and assessments. The facility failed to ensure Resident #1 received the Occupational Therapy that was recommended by the IDT meeting on 08/29/25. This failure placed residents at risk of not receiving needed specialized services that could impact their healing.

Inspectors wroteBased on interview and record review, the facility failed to complete a discharge summary that included a recapitulation of the resident's stay that included diagnoses, course of treatment, pertinent labs, a final summary of the resident's status and reconciliation of all pre-discharge medications with the resident's post-discharge medications for 1 of 5 residents (Resident #1) reviewed for closed records. The facility failed to ensure Resident #1 was discharged from the facility with a discharge summary that included an accurate and current description of the clinical status of the resident. The facility failed to provide the required notice to the Office of the long-term Care Ombudsman regarding the discharge of Resident#1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents were free from abuse for three (Residents #1, #3, and #4) of five residents reviewed for abuse. The facility Administrator and DON failed to protect Resident #1, Resident #3, and Resident #4 from abuse by Resident #2. On 09/09/25, Resident #2 pushed the wheelchair of Resident #4. Resident #4 hit Resident #2. Resident #2 hit Resident #4 back. On 09/29/25 Resident #2 cursed at Resident #1 and Resident #3. He also pulled out a knife from his shoe and threatened them with it. On 10/02/25 Resident #2 threated to kill Resident #1 and chased after her on 10/02/25. Resident #1 suffered psychosocial harm. An IJ was identified on 10/02/25. The IJ template was provided to the facility on [DATE] at 4:50 PM. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents had the right to be free from neglect for 1 (Resident #1) of 9 residents reviewed for neglect. 1. The facility failed to ensure Resident #1 was not neglected when she fell from her bed and remained on the floor beside her bed for approximately 4 hours on 07/30/25. 2. The facility failed to ensure RN A and CNA B did Routine Resident Checks every 2 hours on Resident #1 during their shift on 07/30/25. The non-compliance was identified as past non-compliance. The facility corrected the non-compliance before surveyor's entrance. These failures could place residents at risk for humiliation, fear, shame, agitation, decreased quality of life and possibly death.

Inspectors wroteBased on interviews and record review, the facility failed to assess a resident using the quarterly review instrument specified by the State and approved by CMS not less frequently than once every 3 months for 2 of 19 residents (Residents #7 and Resident #48) reviewed for quarterly assessments. 1. The facility did not ensure Resident #7's Quarterly MDS Assessment, dated 03/12/2025, was completed within 90 days of the previous assessment. 2. The facility did not ensure Resident #48's Quarterly MDS Assessment, dated 03/19/2025, was completed within 90 days of the previous assessment. These failures could place residents at risk of not having their assessments completed timely.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a resident who was unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming, and personal/oral hygiene for one (Resident #67) of five residents reviewed for Activities of Daily Living (ADLs). The facility failed to ensure Resident #67 received personal hygiene care, in respect to facial hair across her chin. This failure could place residents who were dependent on staff for ADL care at risk for not having their care and treatment needs met.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to label drugs and biologicals used in the facility in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable for one medication cart (200 hall) of the facility's' four medication carts reviewed for medication storage. The facility failed to ensure Residents #47 Basaglar Kwik pen 100unit/1ml, and Resident#11 Humulin 70/30 100 units/ml, were dated when opened. The facility failed to ensure that an opened bottle of Novolin 70/30 bottle was properly labeled and dated before storing in the 200-hall medication cart. This failure could affect residents by diminishing the effectiveness, and therapeutic benefits of the medications and/or result in medication error.

Inspectors wroteBased on interview and record review, the facility failed conduct a Comprehensive Assessment within 14 calendar days after admission for 1 of 5 residents (Resident #111) reviewed for Comprehensive Assessments and timing. The facility failed to ensure a Comprehensive MDS Assessment for Resident #111 was completed within 14 days after her admission to the facility. This failure could place residents at risk for improper or incorrect care and services necessary for their physical, mental, and psychosocial well-being.

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a baseline care plan for each resident that included instructions needed to provide effective and person-centered care for the resident that met professional standards of care within 48 hours of the resident's admission for two (Resident #4 and Resident #111) of six residents reviewed for baseline care plans. The facility failed to complete a baseline care plan for Resident #4 and Resident #111 within 48 hours of their admissions. This failure could place newly admitted residents at risk of not receiving effective and person-centered care and services.

Inspectors wroteBased on observations, interviews, and record review the facility failed to establish and 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. The facility failed to maintain sanitary, clean, and safe medication storage and preparation. This failure placed residents at risk for healthcare associated cross contamination and blood borne infections.

Inspectors wroteBased on interview, observation, and record review, the facility failed to ensure the resident's responsible party had the right to exercise the resident's rights for one (Resident #1) of 4 residents reviewed for resident rights. The facility failed to ensure Resident #1's representative was involved in the decision making before providing a haircut and beard trim. This failure could place residents at risk of not having their preferred responsible party represent them in care decisions. Findings Included: Record review of Resident #1's face sheet revealed Resident #1 was an [AGE] year-old male who was admitted to the facility on [DATE] and readmitted on [DATE] from a short-term care hospital. Also, Resident #1's face sheet identified his representative was a family member. Diagnosis included: [...]

Inspectors wroteBased on interviews and record review, the facility failed to ensure sufficient nursing staff with appropriate competencies and skills set to provide nursing and related services for one (Hospitality Aide A) of three employees reviewed for staff qualifications. 1. The facility failed to ensure Hospitality Aide A had a current nurse aide certification while employed at the facility while actively providing care for residents on 02/12/25: 6:00 AM - 2:00 PM shift, 02/10/25: 6:00 AM - 2:00 PM shift, 02/08/25: 6:00 AM - 2:00 PM shift, 02/07/25: 6:00 AM - 2:00 PM shift. This failure could result in residents being provided care by staff who do not have the training and competency needed for providing care.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the residents environment remained as free of accident hazards as is possible and ensure each resident received adequate supervision for 1 of 4 residents (Resident #27) reviewed for accidents and supervision. 1) The facility failed to ensure Resident #27 had adequate supervision when he eloped from the facility on 11/12/24 at 4:41 p.m. The resident left the building through a door which did not sound an alarm when he exited. On 11/13/24, the police found Resident #27 when he attempted to enter a school. The police returned Resident #27 to the facility at 8:24 a.m. Resident #27 was gone from the facility over 15 hours and his whereabouts during the time he was missing were unknown. 2) The facility failed to ensure all exit doors were armed to go off with an alarm sound to notify staff the door was opened. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide supervision to prevent accidents for 2 of 10 residents (Resident # 55 and Resident #12) reviewed for Accidents and Supervision. The facility did not provide supervision for Resident #55 and Resident #12 while smoking on 08/30/24. This failure could place residents at the facility at risk of injuries related to burns.

Inspectors wroteBased on interview and record review, the facility failed to ensure that the resident had the right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences of 1 (Resident #44) of 5 residents reviewed for accommodation of needs. 1. The facility failed to ensure that Resident #44 had a mobility device that was operable and comfortable to her that promoted independence, safety, and psychosocial need. This failure could place residents at risk of increased isolation, depression and increased risk of injury. Findings Include: Record Review of Resident #44's Quarterly MDS with an ARD of 07/13/24 revealed an [AGE] year-old female who admitted to the facility on [DATE]. Resident #44's active diagnoses included: [...]

Inspectors wroteBased on observation, interviews, and record review, the facility failed to resolve a grievance in a timely manner for 1 of 5 (Resident #44) residents reviewed for grievances. 1. The facility failed to make prompt efforts to ensure Resident #44's grievance was initiated, reported, and resolved in a timely manner. These failures could affect the Resident's ability to file a grievance without the fear of discrimination, reprisal or retribution and their right to have their grievances resolved in a timely manner. Findings Included: Record Review of Resident #44's Quarterly MDS with an ARD of 07/13/24 revealed an [AGE] year-old female who admitted to the facility on [DATE]. Resident #44's active diagnoses included: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure the MDS (Minimum Data Set) assessment accurately reflected the resident's status for 1 (Resident #55) of 5 resident's reviewed for MDS assessment accuracy. The facility failed to ensure Resident #55's Quarterly MDS assessment with an ARD (assessment reference date) of 05/14/2024, reflected his current diagnosis of Major Depressive Disorder (clinical depression). This failure could place residents at risk of not receiving care and services to meet their needs. Findings Included: Record Review of Resident #55's Quarterly MDS with an ARD (Assessment Reference Date) of 05/14/2024 revealed a [AGE] year-old male who admitted to the facility on [DATE]. Resident #55's active diagnoses included: [...]

Inspectors wroteBased on interview and record review the facility failed to submit an accurate PL1 (PASARR Level 1) screening when residents admitted with a diagnosis of Mental Illness, Intellectual Disability or Developmental Disability for 1 (Resident #55) out of 5 residents reviewed for PASARR screenings. The facility failed to submit a new PL1 screening when Resident #55 was diagnosed with Major Depressive Disorder after admission to the facility. These failures could affect residents by not receiving a Level II PASARR Evaluation to access for needed services. Findings Included: Record Review of Resident #55's Quarterly MDS with an ARD of 05/14/2024 revealed a [AGE] year-old male who admitted to the facility on [DATE]. Resident #55's active diagnoses included: [...]

Inspectors wroteBased on interview and record review the facility failed to develop and implement a comprehensive person-centered care plan for each resident that included measurable objectives and time frames that met the residents clinical and psychosocial needs that were identified in the comprehensive assessment for 1 (Resident #55) out of 5 residents reviewed for care plans. The facility failed to ensure that Resident #55's comprehensive care plan included his diagnosis of Major Depressive Disorder. This failure could place residents at risk of having received inadequate interventions not individualized to their care needs and diagnoses. Findings Included: Record Review of Resident #55's Quarterly MDS with an ARD (Assessment Reference Date) of 05/14/2024 revealed a [AGE] year-old male who admitted to the facility on [DATE]. Resident #55's active diagnoses included: [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure that the facility residents received proper treatment and care to maintain mobility and proper foot health for 1 (Resident #11) of 1 residents reviewed for foot care services. The facility failed to provide podiatry services for Residents (Resident #11). This failure could lead to increased potential negative outcomes related to foot health including development of sores, infections, amputation and death for a resident with diabetes.

Inspectors wroteBased on, interview and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 1 (Resident #1) of 5 residents reviewed for pharmacy services. RN B and LVN C failed to document the administration of Ipratropium-Albuterol Inhalation Solution (inhaled treatment used to prevent difficulty breathing and coughing) to Resident #1 as ordered. LVN C failed to document the administration of Robitussin Mucus+Chest Congest Oral Liquid (used for cough and congestion) to Resident #1 as ordered. This failure placed residents at risk of not receiving their medications as ordered by a physician and worsening of their condition.

Inspectors wroteBased on observation, interview, and record review the facility failed to assist in obtaining routine and emergency dental care for 1 out of 5 residents (Resident #55) reviewed for dental services. The facility failed to complete and submit a dental referral for Resident #55 This failure could place Resident's at risk for oral complications, dental pain and diminished quality of life. Findings Included: Record Review of Resident #55's Quarterly MDS with an ARD (Assessment Reference Date) of 05/14/2024 revealed a [AGE] year-old male who admitted to the facility on [DATE]. Resident #55's active diagnoses included: Aphasia (brain disorder that affects the ability to speak or understand language), Hemiplegia following cerebral infarction (weakness on one side of the body following a stroke) and muscle weakness. Resident #55 had a BIMS score of 1 indicating a severe cognitive impairment. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections for three of five residents (Resident #52, Resident #70, and Resident #85) reviewed for catheter care. 1. The facility failed to ensure CNA D and CNA E maintained the foley catheter drainage bag below Resident #52's bladder during a mechanical lift transfer. 2. The facility failed to ensure RN P maintained Resident #70's foley catheter drainage bag below the bladder level during wound care on 06/03/24. 3. The facility failed to ensure Resident #85's catheter bag did not had contact with the floor. This failure placed residents at risk for not receiving care appropriate to address their incontinence.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide pharmaceutical services, including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals, to meet the needs of each resident for 1 medication cart (Nurses cart hall 300) of 3 medication carts reviewed for pharmacy services. The facility failed remove damaged medications from the Nurses Cart hall 300 timely for disposition. This failure could place residents at risk of not having the medication available due to possible drug diversion and at risk of not receiving the intended therapeutic benefit of the medication. Findings Included: Record review and observation on 06/04/24 at 12:17 PM of Nurses Cart Hall 300, with LVN N revealed: [...]

Inspectors wroteBased on observations, interviews and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for the facility's only kitchen in that: 1. The facility failed to ensure food items in the facility refrigerator and freezer had a visible use-by date and covered. 2. The facility failed to discard food stored in the refrigerator that should no longer be consumed. 3. The facility failed to ensure staff were only using clean utensils when accessing bulk foods. These failures could affect residents who received their meals from the facility's only kitchen, by placing them at risk for food-borne illness, and food contamination.

Inspectors wroteBased on observation, interview, and record review, the facility failed to 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 three of sixteen residents (Resident #78, Resident #13, and Resident #51) observed for infection control. 1. The facility failed to ensure that CNA D performed hand hygiene while providing incontinence care to Resident #78 on 06/04/24. 2. The facility failed to ensure that CNA F changed his gloves and performed hand hygiene while providing incontinence care to Resident #13 on 06/04/24. 3. The facility failed to ensure that CNA L changed her gloves and performed hand hygiene while providing incontinence care to Resident #51 on 06/04/24. [...]

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure the right to reside and receive services in the facility with reasonable accommodation of the resident needs for 2 (Resident #6, and Resident #83) of 5 residents reviewed for resident rights. The facility failed to ensure Resident #6 and Resident #83's call light was placed within reach. These failures could place residents at risk of injuries and unmet needs.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide the necessary services for residents who are unable to carry out activities of daily living to maintain good grooming and personal hygiene for 2 (Resident #53, Resident #74) of 8 residents reviewed for ADLs. The facility failed to ensure: 1- Resident #53 had her fingernails cleaned and trimmed. 2- Resident #74 had his fingernails cleaned and trimmed. This failure could place residents who were dependent on staff for ADL care at risk for loss of dignity, risk for infections and a decreased quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that based on the comprehensive assessment of a resident, the residents received treatment and care in accordance with professional standards of practice and the comprehensive person-centered care plan for one of 21 residents (Resident #44) reviewed for quality of care. The facility staff failed to ensure Resident #44's splint was placed on his right arm and hand on 06/04/24 and 06/05/24 per physician orders. These failures could place residents at risk of not receiving the care and treatment needed to meet their needs and could result in decreased Range of Motion and worsening of contractures.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that each resident received adequate supervision for one Resident (Resident #51) of three residents reviewed for supervision. The facility failed to ensure Resident #51 received two-person assist when providing incontinent care. This failure could place residents at risk for accidents and injury.

Inspectors wroteBased on observations, interviews, and record review the facility failed to ensure a resident who was fed by enteral means received the appropriate treatment and services to prevent complications of enteral feeding for 1 of 2 residents (Resident #26) reviewed for feeding tubes. The facility failed to ensure Resident #26's hydration bag for the tube feeding pump was labeled and dated. This failure could result in complications of enteral feedings such as receiving incorrect hydration or elevated risk of infection with using the same hydration bag over multiple days.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the resident environment remained as free of accident hazards as was possible for contaminated sharps disposal bins, attached to one (300 Hall MA Medication Cart) of one 300 Hall MA Medication Cart and one (300 Hall Nurse Medication Cart) of one 300 Hall Nurse Medication Cart reviewed for hazards. MA B failed to ensure contaminated sharps in the sharps bin attached to the 300 Hall MA Medication Cart, were below the full line. MA B failed to ensure medications found on the sharps bin insert lid on the 300 Hall MA Medication Cart, were disposed of properly. RN C failed to ensure contaminated sharps in the sharps bin attached to the 300 Hall Nurse Medication Cart, were below the full line. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide pharmaceutical services, including procedures that assure the accurate dispensing and administering of all drugs and biologicals to meet the needs of each resident for 2 (Resident # 15 and #20) of 3 residents reviewed for pharmacy services. MA B failed to administer medications timely as ordered by physician to Resident # 20 LVN D failed to administer medications timely as ordered by physician to Resident # 15 The deficient practice could place residents at risk of not receiving the therapeutic effects from their medications as intended by the prescribing physician order.

Inspectors wroteBased on observation, interview and record review, the facility failed to store all drugs and biologicals in locked compartments and permit only authorized personnel to have access for one (300 Hall MA Medication Cart) of six of six medication carts reviewed for medication storage. MA B failed to ensure medications found on the sharps bin insert lid on the 300 Hall MA Medication Cart, were disposed of properly. This failure placed residents at risk for unauthorized access to the medication cart and a harmful medication can be consumed placing residents at risk for administration of harmful medication.

Inspectors wroteBased on observations, record review, and interviews, the facility failed to ensure an environment that was free of accident hazards and that each resident received adequate supervision to prevent elopement for 1 (Resident #1) of 6 residents reviewed for quality of care. 1. The facility failed to ensure Resident #1 was provided with adequate supervision to prevent him from eloping from the facility on 11/28/23. 2. The facility failed to ensure an exterior door alarm was reset and functioning properly after allowing an outside vendor to utilize the door for a delivery. The facility concluded Resident #1 eloped through the facility's exit door that did not alarm when opened. The non-compliance was identified as past non-compliance. The Immediate Jeopardy (IJ) began 11/28/23 and ended on 11/30/23. The facility corrected the non-compliance before surveyor's entrance. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure all residents had a means to call for staff assistance through a communication system which relays the call directly to a staff member or to a centralized staff work area for 2 (Residents #3 and #4) of 9 residents reviewed for resident call systems. Residents #3 and #4 were moved to the same room on a covid unit for quarantine after testing positive for the virus. The room did not contain a call system for use at the bedside. This failure could place residents at risk of not being able to notify staff when care was needed.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medications were labeled and stored in accordance with currently accepted professional principles for one of six medication carts reviewed for medication storage; the facility failed to, in accordance with State and Federal laws, ensure all drugs were stored in locked compartments under proper temperature controls, and permit only authorized personnel to have access to these drugs, to meet the needs of each resident, for one (Resident #75) of four residents reviewed for medication storage; the facility failed to store all drugs and biologicals in locked compartments and permit only authorized personnel to have access to keys for two (300-hall) of three medication and treatment carts. 1. The 300 and 400 Hall medication cart had 2 insulin pens that had no resident listed or open/expiration dates. 2. [...]

Inspectors wroteBased on observation, interviews, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for kitchen sanitation. The facility failed to ensure food was properly stored in the facility's kitchen. This failure could place residents at risk for food-borne illness.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents had the right to a safe, clean, comfortable, and homelike environment, which included but not limited to receiving treatment and supports for daily living safely for one (Resident #57) of three residents reviewed for environment. The facility failed to ensure Resident #57 bedside commode was clean and sanitary. This failure could place residents at risk for a diminished quality of life due to the lack of a clean and sanitary homelike environment.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that residents receive proper treatment and care to maintain good foot health for one (Resident #75) of five residents reviewed for foot care. The facility failed to ensure Resident #75 received foot care. This failure could place residents at risk of diminished quality of life by not receiving care and services to meet their needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident received appropriate treatment and services to prevent urinary tract infections for one (Resident #75) of three residents observed for indwelling urinary catheters. The facility failed to ensure Resident #75's catheter bag was changed as ordered by the physician. These failures could place residents with urinary catheters at risk for urethral tears, dislodging of the catheter, and urinary tract infections.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents who are fed by enteral means received the appropriate treatment and services to prevent complications of enteral feeding for 1 of 2 residents (Resident #24) reviewed for gastrostomy tube management. The facility failed to ensure Resident #24's head of bed was elevated at a minimum of 30-degree angle during medication administration and bolus feeding (a way to deliver food directly to the stomach) via gastrostomy tube (G-tube) (A tube directly inserted through the skin to the stomach to deliver nutrition). [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure each resident who needs respiratory care is provided such care, consistent with professional standards of practice, the resident's care plan, and the resident's goal and preferences for one (Resident #26) of two residents reviewed for tracheostomy care. The facility failed to dispose of Resident #26's suction catheter after use. These failures placed the residents at risk of respiratory infections.

Inspectors wroteBased on observation, interview and record review the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing and administering of all drugs and biological's) to meet the needs of each resident, for 2 of 5 residents (Residents #50 and # 78) observed during medication administration. The facility failed to ensure Resident #50's and Resident #78's medications were administered at the scheduled time per the physician orders. This failure could place residents at risk for not receiving therapeutic effects of their medications and possible adverse reactions.

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain an infection prevention and control program designated to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable disease and infection for two (Residents #50 and #23) of four residents reviewed for infection control. MA X failed to disinfect the blood pressure cuff in between blood pressure checks for Residents #50 and #23. This failure could place residents at-risk of cross contamination which could result in infections or illness.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that the daily nurse staffing was posted as required. The facility failed to post the daily staffing information posting from 04/20/23 to 04/23/23. This failure could place the residents, families, and visitors at risk of not having access to information regarding the daily nurse staffing data and facility census.