Elderwood at Ticonderoga

Inspectors wroteBased on record review and interviews conducted during an abbreviated survey (Case #2577186), the facility did not ensure they immediately consulted with the resident's physician when there was a significant change in condition for one (1) (Residents #1) of one (1) resident reviewed for significant changes. Specifically, for Resident #1 the physician was not notified that the resident had pulled out the urinary catheter. This is evidenced by:The Facility's Policy and Procedure titled, Change in Resident Condition Assessment, last modified 4/12/2018, documented; A change of condition is defined as a major change in the resident's status that: 1. Is not self-limiting. 2. Impacts one or more areas of health status. 3. Requires review/revision of the care plan. The procedure staff were to follow was documented as: 1. The change of condition is documented in the resident's medical record. 2. [...]

Inspectors wroteBased on record reviews and interviews conducted during an abbreviated survey (Case #2577186), the facility did not ensure that a resident with an indwelling catheter, received the appropriate care and services in accordance with professional standards of practice. Specifically, there was no documented evidence that resident's catheter care was provided. This is evidenced by:A review of facility policies documents that the facility had policies for insertion of an indwelling catheter for male patients last modified on 1/23/2028, removal of supra-pubic or indwelling catheter last revised on 4/11/2028, and the daily care of an indwelling catheter last modified on 11/22/2023. The policies did not address unintended removal of a catheter. [...]

Inspectors wroteBased on observation, record review, and interviews during a recertification survey, the facility did not ensure the provision of nutritional and hydration care and services to each resident, consistent with the resident's comprehensive assessment, therapeutic diet, and preferences for 4 (Residents #3, #23, #24 and #63) of 5 residents reviewed. Specifically, Residents #3, #23, and #63 were not monitored for weight loss, assessed when significant weight loss occurred, and did not receive correct meals consistent with physician ordered diets and recommendations for meal/caloric intake. Additionally, Residents #24 and #63 were not monitored for dehydration and beverages were not offered throughout the day. This is evidenced by: Cross-referenced to F805: Food in Form to Meet Individual Needs and F804: [...]

Inspectors wroteBased on observations, record review, and interviews during a recertification survey, the facility did not ensure food was prepared in a form designed to meet the individual needs for 5 of 5 residents (Residents #3, #10, #23, #35, and #48) reviewed for diet consistency. Specifically, the Resident #3, #10, #23, #35, and #48 received meals that were not consistent with their physician ordered diets. This is evidenced by: Cross-referenced to F692: Nutrition/Hydration The facility policy, Nutrition and Hydration Needs, last revised 7/19/2018, documented the Registered Dietitian or Diet Technician would assess the nutritional needs of each resident upon admission and as needed. Factors used to estimate needs included but were not limited to the resident ' s diagnosis, comorbidities, lab values and skin status. [...]

Inspectors wroteBased on record review, observation, and interview during the recertification survey, the facility did not ensure each resident received food and drink that was palatable, flavorful, and at an appetizing temperature for 2 of 2 test trays (the 7/09/2024 and 7/10/2024 lunch meals) reviewed. Specifically, food and beverages served to residents for the 7/09/2024 and 7/10/2024 lunch meals on the Adirondack and Patriot main Dining Room were not palatable. Additionally, multiple residents complained of food palatability during the monthly facility Food Forum meetings. This was evidenced by: Food Forum Meeting documentation included the following concerns: - On 5/06/2024 all residents in attendance stated the soups lacked consistency. Some items such as rice, pork chops, and chicken were dry. One unnamed individual stated their hamburger was served on bread instead of a hamburger bun. [...]

Inspectors wroteBased on observations, record review, and interviews during a recertification survey, the facility did not ensure the resident had a right to be treated with respect and dignity, including: The right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident's medical symptoms for 1 (Resident #47) of 4 residents reviewed for restraints. Specifically, Resident #47 had a chair alarm (a pad placed on a chair) hooked to a sensor box that alarmed if a resident attempted to stand) on their wheelchair to alert staff if they attempted to stand up. This is evidenced by: Resident #47 was admitted to the facility with diagnoses of dementia with mood disturbance, a stroke (a medical condition in which poor blood flow to the brain causes cell death), and generalized muscle weakness. [...]

Inspectors wroteBased on observations, record review, and interviews, during a recertification survey, the facility did not ensure it developed and implemented a comprehensive person-centered care plan for each resident, consistent with the resident rights for 1 (Resident #47) of 20 residents reviewed for comprehensive care plans. Specifically, Resident #47 did not have a comprehensive care plan for the chair alarm (a pad placed on a chair that is hooked to a sensor box). It alarmed if a resident attempted to stand) on their wheelchair to alert staff if they attempted to stand up. This is evidenced by: Resident #47 was admitted to the facility with diagnoses of dementia with mood disturbance, a stroke, and generalized muscle weakness. The Minimum Data Set (an assessment tool) dated 7/04/2024, documented the resident had severe cognitive impairment, could be understood, and could understand others. [...]

Inspectors wroteBased on observations, record review, and interviews during a recertification survey, the facility did not ensure that it provided, based on the comprehensive assessment, care plan, and the preferences of each resident, an ongoing activities program to meet the interests of and support the physical, mental, and psychosocial well-being of each resident for 2 (Resident #'s 10 and 24) of 3 residents reviewed for activities. Specifically, Resident #'s 10 and 24 were not provided with activities on an ongoing basis according to the residents' Comprehensive Care Plan and activities provided did not meet the residents' preferences. This is evidenced by: [...]

Inspectors wroteBased on observation, record review, and interviews conducted during a recertification survey, the facility did not provide pharmaceutical services including procedures that assured the accurate dispensing and administering of all drugs and biologicals according to professional standards for 1 (Resident #21) of 11 residents reviewed. Specifically, Resident #21 was observed being administered a controlled substance which was not signed out on the controlled Drug and the medication was documented as administered on the Medication Administration Record. This is evidenced by: The facility ' s Medication Administration Policy and Procedure effective 1/25/2024, documented under Administration of Controlled Substances section, the registered nurse/licensed practical nurse would sign for the needed dose for the resident on the Controlled Drug Receipt record. [...]

Inspectors wroteBased on observation, record review, and interviews conducted during a recertification survey, the facility did not ensure drugs and biologicals were labeled and stored in accordance with professional standards of practice in 1 of 2 medication carts reviewed for medication storage. This is evidenced by: The facility policy Medication Administration Methods, dated [DATE] documented medication expiration dates should be checked prior to administration. No facility policy was provided regarding the requirements for labeling insulin pens with the observed sticker showing the date opened and date of expiration. During an observation of the Patriot Unit medication cart on [DATE] at 11:33 AM with Licensed Practical Nurse #3, there was 1 opened Basaglar (glargine, long-acting insulin) Kwik insulin pen with a sticker documenting the date opened without the expiration date filled out. [...]

Inspectors wroteBased on record review and interviews during a recertification and abbreviated survey (Case #NY00307330), the facility did not ensure that a thorough and accurate investigation was conducted after an injury of an unknown origin was observed for one (Resident #48) out of three residents reviewed for incident investigations. Specifically, when Resident #48 was observed with bruising to their right eye on 12/07/2022 which was of an unknown origin, the facility did not conduct an investigation. This is evidenced by: Resident #48 was admitted to the facility with diagnoses of unspecified dementia, dysphagia (difficulty swallowing) and cognitive communication deficit. The Minimum Data Set (an assessment tool) dated 4/30/2024, documented the resident had severe cognitive impairment for decisions of daily living, could usually be understood and could usually understand others. [...]

Inspectors wroteBased on observation, record review, and staff interview during the recertification survey, the facility did not maintain food preparation areas in accordance with professional standards for food service safety. Food preparation and serving areas and equipment are to be kept clean, and a test kit is to be provided to measure the parts per million (ppm) concentration of the solution used to sanitize equipment. Specifically, food contact equipment in the main kitchen and 3 of 3 kitchenettes were not clean, and an accurate test kit was not provided. This is evidenced as follows. The main kitchen and the kitchenettes were inspected on 09/19/2021 at 10:24 AM. [...]

Inspectors wroteBased on observation and interview during the recertification survey the facility did not maintain drugs and biologicals labeled in accordance with currently accepted professional standards on 1 (Unit 2) of 2 nursing units inspected. Specifically, the facility did not ensure that medications designed for multiple administrations (insulin) located in one (Unit 2 Medication Cart #2) of two medication carts were labeled with the date they were opened. This is evidenced by: The Policy and Procedure titled Medication Carts last revised 2/6/2019, documented all medications that require date when opened will be properly labeled and discarded according to manufacturer's recommendations. The manufacturer's instructions for insulin glargine pen injector documented to discard opened pen after 28 days. [...]

Inspectors wroteBased on observation, and interviews during the recertification survey, the facility failed to maintain an effective infection control program designed to provide written standards for when and to whom possible incidents of communicable disease or infections should be reported. Specifically, on 9/19/2021, the facility did not ensure that an employee (DC #1) received a viral test for COVID-19 as soon as possible after multiple administrative facility staff members learned of or were provided with the knowledge that the employee was self-reporting symptoms consistent with COVID-19 and when one administrative staff member was also informed that DC #1 was observed exhibiting symptoms consistent with COVID-19. This was evidenced by: [...]

Inspectors wroteBased on observation and staff interview during the recertification survey, the facility did not provide effective housekeeping and maintenance services. Specifically, the facility did not ensure that on 2 (Adirondack Unit and Patriot Unit) of 2 resident units the walls and floors were clean and/or in good repair. This is evidenced as follows. The Adirondack Unit and Patriot Unit were inspected on 09/21/2021 at 1:13 PM. The corridor floor next to door frames on the Patriot Unit, and on Adirondack Unit, the carpeting in the corridors and the floors in resident rooms 204, 212, 214, 215, and 218 were soiled with dirt and/or old wax buildup. On the Adirondack Unit, the wallpaper and/or the vinyl wall coving base were peeling in resident rooms [ROOM NUMBERS] and the resident area support column. [...]

Inspectors wroteBased on observation and staff interview during the recertification survey, the facility did not dispose of garbage and refuse properly. Specifically, dumpsters were not maintained in a sanitary condition. This is evidenced as follows. The garbage dumpsters and area were inspected on 09/19/2021 at 10:24 AM. The leftmost dumpster was missing its top cover, a black oily liquid was leaking onto the asphalt, and flies were noted around this dumpster; the third dumpster from the left was open; and the grounds around the dumpsters were littered with broken glass. The Food Service Director stated in an interview on 09/19/2021 at 11:45 AM, that Environmental Services will be contacted about having the dumpsters repaired, the area will be cleaned, and the porters will be educated on keeping the dumpsters closed. [...]

Inspectors wroteBased on observation and interview during the recertification survey, the facility did not ensure it stored, prepared, distributed, and served food in accordance with professional standards for food service safety. Specifically, the unit kitchenettes contained expired and undated foods. This was evidenced as follows: During observations of both unit kitchenettes on 4/26/2019 at 10:49 AM, the resident refrigerator on the Adirondack Unit had a container of mayonnaise with a best-by-date of 8/21/18. There was no thermometer in the resident freezer. The Patriot Unit resident refrigerator contained a bottle of vegetable juice that had been opened on 4/11/2019 and had a use-by-date of 4/21/19. A tube of Gogurt yogurt had an expiration date of 3/27/19. Two cartons of vanilla latte had use-by-dates of 3/28/19; [...]

Inspectors wroteBased on observation and staff interview during the recertification survey, carbon monoxide detection was not provided in accordance with adopted regulation. The International Fire Code, 2015 Edition Section 915 Carbon Monoxide Detection, requires carbon monoxide detection in all areas with gas operated equipment. Section 4.1 carbon monoxide alarms shall receive their primary power form building wiring served from a commercial source or be power by a 10-year battery. Specifically, the carbon monoxide detection alarms were not hardwired to a commercial power source or have a 10-year battery. This is evidenced as follows. Observations on 04/23/2019 at: 9:35 AM, revealed a carbon monoxide detector in the laundry room and in the kitchen. Both carbon monoxide detectors were not hardwired to a commercial power source or have a ten year battery. [...]

Inspectors wroteBased on observation, record review and interview duirng a recertification survey, the facility did not establish and maintain an infection prevention and control program designed to help prevent the development and transmission of communicable diseases and infection determined for 2 of 2 dressing changes observed for Resident #37 and Resident #59. Also, written standards, policies and procedures for the program must include, but are not limited to standard and transmission-based precautions to be followed to prevent spread of infections. Specifically for Resident #37, the facility did not ensure standard precautions were maintained during a dressing change to the resident's left buttock stage 2 decubitus ulcer and Resident #59's dressing change to the resident's right foot unstageable pressure ulcer. [...]

Inspectors wroteBased on interviews conducted during a recertification survey, the facility did not ensure each resident was treated in a dignified manner for one (1) (Resident #50) of nineteen (19) residents reviewed. Specifically, the facility did not identify a resident to resident conflict involving Resident #50 and Resident #50's roommate. Resident #50 would not enter her room for fear of being yelled at by her roommate and was encouraged by staff to utilize a general bathroom instead of the bathroom in her room, as to not disturb her roommate. This is evidenced by: Resident #50: The resident was admitted on [DATE], with diagnoses of Dementia, depression, cognitive communication deficit, chronic ulcers on the lower extremities, and coronary artery disease. The Minimum Data Set, dated [DATE] documented the resident had severely impaired cognition, and regularly wandered within the facility. [...]

Inspectors wroteBased on record review and interviews during a recertification survey, the facility did not ensure the resident and/or resident representative were provided with timely and specific notification when the facility determined that the resident no longer qualified for Medicare Part A skilled services and the resident had not used all the Medicare benefit days for that episode for two of two residents reviewed. Specifically: for Resident #'s 54 & 65, the Skilled Nursing Facility Advance Beneficiary Notice (SNFABN), form CMS-10055, did not include an accurate reason for the possibility for Medicare's denial of payment and did not include the resident's option choice to pay for the continuation of services or for the cessation of services, the resident's Medicare appeal rights for each option choice. This is evidenced by: [...]

Inspectors wroteBased on interviews and record review during a recertification survey, the facility did not develop and implement a baseline care plan for each resident that included the instructions needed to provide effective and person-centered care of the resident that met professional standards of quality care for 2 (Resident's #3 and #126) of 17 resident's reviewed for baseline care plans. Specifically, for Residents #3, the facility did not ensure a baseline care plan was developed within 48 hours of admission and for Resident #126, there was no documentation that a summary of the resident's baseline careplan was provided to or reviewed with the resident's representative This is evidenced by Resident #3: The resident was admitted to the facility on [DATE], with a diagnosis of Alzheimer's Disease, chronic pain, muscle weakness, pruritis, hyperlipidemia, and insomnia. [...]

Inspectors wroteBased on observation, record review and interview during a recertification survey, the facility did not ensure comprehensive person-centered care plans were developed and implemented for two (2) (Resident #'s 126 and #50) residents of nineteen (19) reviewed that included measurable observations and time frames to meet a resident's medical, nursing, mental and psychosocial needs. Specifically; for Resident #126, the facility did not ensure a care plan was developed for the treatment of bilateral leg edema, and for Resident #50, the facility did not ensure the intervention for the use of chair alarms was in place per the comprehensive care plan for safety. This is evidenced by: Resident #126: The resident was admitted to the facility on [DATE] with the diagnoses of dementia with behavioral disturbance, pressure ulcers to right and left buttocks and peripheral vascular disease. [...]

Inspectors wroteBased on observation, record review and interviews during the recertification survey, the facility did not ensure each resident was offered sufficient fluid intake to maintain proper hydration and health for one (1) (Resident #67) of one (1) resident reviewed for hydration. Specifically, for Resident #67, the facility did not ensure fluids were offered and provided to the resident between meals and medications. This is evidenced by: Resident #67: The resident was admitted to the facility on [DATE], with the diagnoses of dementia, pneumonitis due to inhalation of food and vomit, sepsis, and cognitive communication deficit. The Minimum Data Set (MDS) dated [DATE], documented the resident had severely impaired cognition, she was sometimes able to understand and be understood. She required extensive assistance with most ADL's including eating. [...]

Inspectors wroteBased on record review and interview during the recertification survey, the facility did not ensure a policy was developed for the monthly Medication Regimen Review (MRR) that included time frames for the different steps in the process and steps the pharmacist must take when he or she identifies an irregularity that requires urgent action to protect the resident. Specifically, the facility did not ensure that time frames were established for the steps in the MRR process. This is evidenced by: Medication Regime Review by Pharmacy Consultant Policy dated 7/25/18 documented: 1. [...]

Inspectors wroteBased on observation, interviews and record review during a recertification survey, the facility did not ensure that the medication regime for one (1) (Resident #77) of five (5) residents reviewed for unnecessary medications was free from unnecessary medications. Each resident's entire drug/medication regimen is managed and monitored to promote or maintain the resident's highest practicable mental, physical, and psychosocial well-being; PRN orders for pain medications are only used when the medication is necessary and PRN use is limited for one. Specifically, for Resident #77, the facility did not ensure that the resident was not provided with an as needed (PRN) pain medication an without indication for use. This is evidenced by: A Policy for Pain Management dated 4/10/18, documented a verbal pain scale will be utilized to evaluate the resident's pain experience. [...]

Inspectors wroteBased on observation, interviews and record review during a recertification survey, the facility did not ensure that the medication regime for one (1) (Resident #77) of five (5) residents reviewed for unnecessary medications was free from unnecessary medications. Each resident's entire drug/medication regimen is managed and monitored to promote or maintain the resident's highest practicable mental, physical, and psychosocial well-being; PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited for one. Specifically, for Resident #77, the facility did not ensure that the resident was not provided with an as needed (PRN) psychotropic medication without an indication for use. This is evidenced by: Resident #77: [...]