Dumont Center for Rehabilitation and Nursing Care

Inspectors wroteBased on observation, record review, and interviews conducted during the Recertification and Abbreviated (iQIES Complaint 646935) Survey, the facility failed to ensure that residents' comprehensive care plans were reviewed and revised by the interdisciplinary team periodically and after each comprehensive and quarterly review assessments. Additionally, the facility failed to ensure that a quarterly care plan meeting was held for each resident. This was evident for three (3) (Residents #35, #209 and #149) of 36 total sampled residents. [...]

Inspectors wroteBased on observation, record review, and interviews, the facility failed to ensure that sufficient nursing staff were available to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial wellbeing of each resident. Specifically, the facility reported short staffing on weekends confirmed by a review of the Daily Staffing and the Payroll Based Journal Staffing Data Report, and interviews with the Resident Council and other residents and representatives.

Inspectors wroteBased on observation, record review, and interviews, the facility failed to ensure that food was served at an appetizing temperature during meal service. This was evident for two (2) of six (6) units observed during Dining Observation. Specifically, foods served during lunch meal service were not maintained at palatable and appetizing temperatures.

Inspectors wroteBased on observation, record review, and interviews, the facility failed to ensure infection control practices and procedures were maintained to provide a safe and sanitary environment to help prevent the development and transmission of communicable diseases and infections. This was evident for two (2) (Residents #1 and #213) of four (4) residents reviewed for Pressure Ulcer/Injury out of 36 total sampled residents. Specifically, Registered Nurses #8 and #9 failed to practice hand hygiene during wound care and Registered Nurse #9 removed unused wound dressing supplies from Resident #213's room and placed them back in the treatment cart.

Inspectors wroteBased on observation, record review, and interviews conducted during the Recertification and Abbreviated Survey (iQIES Incident 646938), the facility failed to ensure that the resident or their representative participated in all aspects of person-centered care planning. This was evident for one (1) (Resident #211) of two (2) residents reviewed for care planning out of 36 total sampled residents. Specifically, Resident #211's representative was not afforded the opportunity to participate in the resident's care planning process. The facility's policy titled Resident Assessment Instrument and Care Planning Process dated 11/06/2025 stated resident and /or resident's family will be invited to attend the interdisciplinary care plan meeting for comprehensive assessments. [...]

Inspectors wroteBased on record review, and interviews during the Recertification and Abbreviated (2680670) Survey, the facility did not ensure that all alleged violations involving abuse, neglect, including injuries of unknown source were reported immediately, but not later than 2 hours after the allegation was 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, to the New York State Department of Health. This was evident for one (1) (Resident #35) of two (2) residents reviewed for Dignity out of 36 total sampled residents. Specifically, the Ombudsman reported to the Director of Nursing that Resident #35 alleged that a Nurse Practitioner verbally abused them. [...]

Inspectors wroteBased on observation, record review, and interviews conducted during the Recertification and Abbreviated Survey (iQIES Complaint 2680670), the facility failed to ensure that all alleged violations involving abuse were thoroughly investigated. This was evident for one (1) (Resident #35) of two (2) residents reviewed for dignity out of 35 total sampled residents. Specifically, on 01/05/2026, the facility received a report from the Ombudsman stating that Resident #35 alleged that Nurse Practitioner #1 verbally abused them. The facility failed to maintain evidence that the alleged violation of verbal abuse was thoroughly investigated. Cross Reference F609 Reporting of Alleged Violations

Inspectors wroteBased on observation, record review, and interviews conducted during the Recertification and Abbreviated (iQIES Complaint 646935) survey, the facility failed to ensure that services provided met professional standards of quality. This was evident for one (1) (Resident #209) of four (4) residents reviewed for Discharge out of 36 total sampled residents. Specifically, Resident #209, who had no discharge order for intravenous therapy, was discharged home with an intravenous access device left in place. In addition, the resident was given discharge medications that belong to a different resident. Cross Reference:

Inspectors wroteBased on observation, record review, and interviews, the facility failed to ensure residents receive treatment and care in accordance with professional standards of practice, and comprehensive person-centered care plan. This was evident for one (1) (Resident #163) of five (5) residents reviewed for Unnecessary Medications out of 36 total sampled residents. Specifically, Resident #163, who had a diagnosis of Diabetes Mellitus, had a physician's order to notify the physician when resident's finger stick blood sugar (method of drawing drops of blood from the finger for testing the blood glucose level) result is less than 60 milligrams per deciliter or more than 351 milligrams per deciliter. There was no documented evidence that the physician was notified when Resident #163's finger stick blood sugar was higher than 351 milligrams per deciliter on multiple occasions.

Inspectors wroteBased on observation, record review, and interviews, the facility failed to ensure that residents receiving enteral feeding received appropriate care and services to prevent complications of enteral feeding. This was evident for one (1) (Resident #12) of 27 residents reviewed for medication administration task. Specifically, Registered Nurse #6 did not appropriately verify placement of gastrostomy tube prior to administering medications and enteral feeding.

Inspectors wroteBased on observation, record review, and interviews conducted during the Recertification and Abbreviated (iQIES Complaint 646935) and Recertification survey, the facility failed to ensure that parenteral fluids were administered consistent with professional standards of practice. This was evident for one (1) of four (4) residents (Resident #209) reviewed for Discharge out of 36 total sampled residents. Specifically, Resident #209 did not receive appropriate care and services for their prescribed intravenous therapy. Medical records lacked ongoing monitoring of the resident's intravenous access device.

Inspectors wroteBased on observation, record review, and interviews the facility failed to ensure that a resident received necessary respiratory care in accordance with professional standards of practice. This was evident for one (1) (Resident #109) of three (3) residents reviewed for respiratory care out of 36 total sampled residents. Specifically, Resident #109 was observed receiving oxygen via nasal cannula without a physician's order.

Inspectors wroteBased on observation, record review, and interviews, the facility failed to ensure that a resident requiring oral/dental care was promptly referred for dental evaluation and care. This was evident for one (1) (Resident #133) of one (1) resident reviewed for dental out 36 total sampled residents. Specifically, Resident #133 was observed with missing dental caps, and stated on interview that they have not been evaluated by a dentist since being admitted in 03/2025.

Inspectors wroteBased on observation, record review, and interviews, the facility failed to ensure garbage and refuse were disposed of properly. This was evident during the Kitchen Observation task. Specifically, the facility's waste dumpster was not kept closed when not in use on multiple occasions which exposed garbage and refuse and had the potential to attract pests.

Inspectors wroteBased on observation and interviews conducted during the recertification survey from 4/24/24 to 5/1/24, the facility did not maintain a safe, clean, comfortable and home-like environment for 1 of 1 resident's rooms (Resident #44/Unit 3North room [ROOM NUMBER]) reviewed for environment. Specifically, Resident #44 was in their room and a maintenance staff was repairing the flooring in their room with glue and there was an odor observed. On 4/24/24 at 2:08 PM Resident # 44 was observed lying in bed in their room while maintenance staff was repairing the flooring in their room. The bed was pushed diagonal to access the flooring that the maintenance staff was attempted to reglue, and the glue had an odor. [...]

Inspectors wroteBased on observations, record review and interview during the recertification and abbreviated surveys (NY00333316), the facility did not ensure that all alleged violations involving abuse and neglect were reported within 2 hours to New York State Department of Health (NYSDOH) for 1 of 2 residents reviewed for abuse. Specifically, Resident #94's family informed the facility of an allegation of sexual abuse on 2/10/24 and facility reported to New York State Department of Health (NYSDOH) on 2/11/24.

Inspectors wroteBased on record review and interviews conducted during the recertification survey from 4/24/24 through 5/1/24, the facility did not ensure a Minimum Data Set Discharge Assessment was completed and transmitted for 1 of 2 residents (Resident #150) reviewed for discharge. Specifically, Resident #150 was discharged from the facility on 2/16/24 and the Minimum Data Set Discharge Assessment had not been done at time of survey.

Inspectors wroteBased on observation, record review, and interviews during a recertification survey (4/24/2024-5/1/2024), the facility did not ensure each resident received care, consistent with professional standards of practice, to prevent pressure ulcers for 1 of 13 (Resident #8) residents reviewed for pressure ulcers. Specifically, Resident #8 had care plan interventions and physicians order recommendations to offload heels with heel booties while in bed; however, the resident was observed in bed with their heels resting directly on the mattress and there was no pillow on the mattress for the resident's feet.

Inspectors wroteBased on observations, record review and interviews during the recertification survey conducted from 4/24/2023 to 5/1/2024 the facility did not ensure that they store, prepare, distribute, and serve food in accordance with professional standards for food service. Specifically, sanitary conditions were not maintained in the main kitchen area. In the dishwasher area, the blue cup racks, which the kitchen staff claimed as clean racks were stored on the floor then later were picked up and combined with other clean racks for further use.

Inspectors wroteREVISED 6/26/24 IDR Based on observations, record review and interviews during a recertification survey from 4/24/24-5/1/24, the facility did not ensure that an infection prevention plan was implemented for identifying, tracking, and monitoring infections, communicable diseases, and outbreaks. Specifically, 1) Clostridium Difficile infections were not documented on the infection line list at readmission from the hospital for 1 of 3 Residents (Resident #101) until 5 days later, 2) measures to prevent the spread of Clostridium Difficile were not implemented to include a private room, and 3) Resident #113's ventilator tubing was not changed within parameters and was 5 days past due.

Inspectors wroteF677 Based on observations, record review and interviews conducted during a recertification survey, the facility did not ensure that the necessary assistance and care were provided to carry out activities of daily living (ADLs) for 2 out of 5 residents (Residents #6 and #331) reviewed for ADLs. Specifically, Residents #6 and #331 were observed on multiple occasions with long, dirty nails, and a dark brown substance under and around the nails.

Inspectors wroteBased on observations, interviews and record review conducted on a recent Recertification Survey it was determined that for one (Resident #110) of five residents screened for unnecessary medications, the pharmacy consultant did not accurately review Resident #110 MAR (Medication Administration Record). Specifically, as a result of failure to identify medications that should be administered on an empty stomach, a resident received Levothyroxine, a medication for a thyroid condition, simultaneously with other medications and a tube feeding.

Inspectors wroteBased on observations, interviews, and record reviews conducted during the Recertification Survey, it was determined that for two of two residents (#56 and #22) reviewed for medication storage, the facility did not provide the safe and secure storage of medications. Specificallly, 1) a cup of medications was left unattended on a residents bed side table and 2) a filled syringe was left unattended on the top of a medication cart.