Cortland Park Rehabilitation and Nursing Center

Inspectors wroteBased on observations and interviews during the recertification survey conducted [DATE]-[DATE], the facility did not ensure drugs and biologicals were stored in accordance with professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable to include proper labeling of medication with resident information and expiration date for 3 (three) of 3 (three) medication carts (Maplewood Unit Cart 1, Parkside Unit Cart 2, and Whispering Pines) reviewed. Specifically, Maplewood Unit Cart 1 contained opened, unlabeled insulin pens and inhalers; Parkside Unit Cart 2 contained eye drops without a resident identifier, and opened, unlabeled insulin pens, eye drops, and inhalers; and Whispering Pines contained opened, unlabeled eye drops.

Inspectors wroteBased on observations, record review, and interviews during the recertification survey conducted 5/27/2025-5/30/2025, the facility did not ensure residents received services with reasonable accommodation of needs for one (1) of one (1) resident (Resident #94) reviewed. Specifically, Resident #94 did not have their call bell in reach.

Inspectors wroteBased on observations, record review, and interviews during the recertification survey conducted 5/27/2025-5/30/2025, the facility did not ensure residents received treatment and care in accordance with professional standards of practice and the comprehensive person-centered care plan one (1) of four (4) residents (Resident #76) reviewed. Specifically, Resident #76 had an unwitnessed fall and was not assessed timely by a qualified professional; their call bell was observed out of reach; and they were not assisted with toileting by Licensed Practical Nurse #9 as planned.

Inspectors wroteBased on observation, record review, and interview during the abbreviated survey (NY00329552), the facility did not ensure a resident with pressure ulcers received the necessary treatment and services, consistent with professional standards of practice, to promote wound healing, prevent infection and prevent new ulcers from developing for 1 of 3 residents (Resident #2) reviewed. Specifically, Resident #2 was found with a skin impairment and was not assessed timely by a qualified professional, and the medical provider was not notified timely of the areas for consideration of a treatment order.

Inspectors wroteBased on observation, record review, and interview during the recertification and abbreviated (NY00324417) surveys conducted 10/16/23-10/20/23, the facility did not ensure residents had the right to a safe, clean, comfortable, and homelike environment for 2 of 3 resident units (Parkside and Whispering Pines Units including resident rooms 201, 202A, 203, 206, 318A and 320A, and Residents #31, #47, and #64). Specifically, there were unclean wheelchairs, medical equipment, common areas, and damaged walls.

Inspectors wroteBased on observation, interview, and record review during the recertification survey conducted 10/16/2023-10/20/2023, the facility did not ensure an ongoing program to support residents in their choice of activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident for 2 of 3 residents (Residents #31 and #100) reviewed. Specifically, Residents #31 and #100 resided on the dementia unit and were not offered meaningful activities and were not provided with activities of their choosing. Additionally, Resident #31's room was not personalized with preferred activity items, such as a television or radio.

Inspectors wroteBased on observation, record review, and interview during the recertification survey conducted 10/16/2023-10/20/2023, the facility did not ensure that residents who required dialysis received such services, consistent with professional standards of practice for 1 of 1 resident (Resident #32) reviewed. Specifically, Resident #32 received hemodialysis (a process of purifying blood when kidneys do not work normally) treatments at a community based dialysis center and did not have ongoing monitoring after dialysis treatments, and there was no evidence of ongoing communication, service coordination, or collaboration between the facility and dialysis staff.

Inspectors wroteBased on observation, record review, and interviews conducted during the recertification and abbreviated (NY00324417) surveys the facility did not ensure residents were free of significant medication errors for 2 of 5 residents (Residents #59 and #68) reviewed. Specifically, Resident #59 had an order to hold their insulin if their finger stick blood glucose (FSBG) level was less than 120 milligrams/deciliter (mg/dl) and the resident received insulin when their FSBG was 77 mg/dl; Resident #68 did not receive nebulizer treatments as ordered.

Inspectors wroteBased on observation, interview, and record review during the recertification survey conducted 10/16/2023-10/20/2023, the facility did not ensure drugs and biologicals were labelled and stored in accordance with currently accepted professional principles and included the appropriate accessory and cautionary instructions when applicable for 1 of 3 medication carts (Maplewood medication cart) reviewed. Specifically, the top drawer of the medication cart contained a cup of unlabeled medications that were removed from their original packaging.

Inspectors wroteBased on observation, record review, and interview during the recertification survey conducted from 10/16/2023-10/20/2023, the facility did not ensure food was stored and prepared in accordance with professional standards for food service safety in the main kitchen and on 1 of 3 units (Parkside Unit) reviewed. Specifically, the walls and floor of the dry storage room in the main kitchen were uncleanable, and there were expired food products in the Parkside Unit nourishment room.

Inspectors wroteBased on observation, record review, and interview during the recertification survey conducted 10/16/2023-10/20/2023, the facility did not ensure call systems were accessible to residents for 1 of 1 resident (Resident #12) reviewed. Specifically, Resident #12 did not have their manual tap bell within reach.

Inspectors wroteBased on observation, record review and interview during the recertification and abbreviated survey (NY00262972) completed on 5/6/2021, the facility did not establish and maintain an infection prevention and control program to ensure the health and safety of residents and to prevent the transmission of COVID-19 for 2 of 4 residents (Residents #8 and 9) observed during medication administration; for 1 resident (Resident #53) observed during a meal; for 2 of 2 residents (Residents #32 and #44) receiving oxygen; and for 1 of 1 resident (Resident #60) with a urinary catheter. Specifically, personal protective equipment was not worn correctly and hand hygiene was not performed during medication administration for Residents #8 and #9; Resident #53 was fed by a certified nursing assistant (CNA) who was not wearing a face mask correctly; [...]

Inspectors wroteBased on observation, record review and interview during the recertification and abbreviated (NY00262972, NY00269888, NY00275233) surveys, the facility did not ensure that residents who were unable to carry out activities of daily living (ADLs) received the necessary services to maintain good nutrition and grooming for 2 of 5 (Residents #14 and 60) reviewed. Specifically, Resident #14 was not assisted at meals as planned to ensure adequate nutritional intake and Resident #60 was not shaved per their preference.