Greene Meadows Nursing and Rehabilitation Center

Inspectors wroteBased on record review and interviews during a survey, the facility failed to ensure each resident was free from misappropriation of resident property and exploitation for one (Resident #1) of three residents reviewed. Specifically, an agency contracted staff person took Resident #1's driver's license, social security card, and bank debit card from their phone case and used the debit card to make purchases from the facility vending machine and a local store.

Inspectors wroteBased on observation, interview, and record review conducted during a survey, the facility failed to ensure a report of the results of all investigations to the administrator or their designated representative and to other officials in accordance with State law, including to the State Survey Agency, within 5 working days of the incident, and if the alleged violation is verified appropriate corrective action must be taken for one (Resident #1) of three residents reviewed. Specifically, the facility reported to The Department of Health a suspected misappropriation of Resident #1's personal property by facility staff on 9/26/2023. The results of the investigation and corrective actions were not submitted.

Inspectors wroteBased on observation and interviews during the recertification survey dated 09/07/2023 through 09/14/2023, the facility did not provide effective housekeeping services on three (3) of 3 resident units and the resident common areas. Specifically, the following ceiling tiles had water stains: [...]

Inspectors wroteBased on observation, record review, and interviews during the recertification survey dated 09/07/2023 through 09/14/2023, the facility did not ensure food was stored, prepared, distributed, or served food in accordance with professional standards for food service safety in the main kitchen and two (2) of 2 kitchenettes. Specifically, in the main kitchen, the facility did not have test papers to check the concentration of the chemical sanitizer in the low-temperature dishwashing machine, and the facility did not have test papers to check the concentration of quaternary ammonium compound (QAC) used to manually sanitize food contact equipment in the 3-compartment sink. In the main kitchen, the slicer was soiled with food particles; the kitchen floor, floor behind cooking equipment, and walk-in freezer floor were soiled with food particles and/or a black build-up; [...]

Inspectors wroteBased on observation, record review, and interviews during the recertification survey dated 09/07/2023 through 09/14/2023, the facility did not ensure food brought for residents by family or visitors (food) was stored in a way that is either separate or easily distinguishable from facility food and was labeled according to the facility policy in two (2) of 2 kitchenettes. Specifically, in the One South Nourishment Station (kitchenette) refrigerator, an insulated bag containing cut watermelon, and cottage cheese did not have an identifying label with a name, date, or room number. In the Second Floor Kitchenette refrigerator, a restaurant entre labeled with a resident name and room number was not dated. This is evidenced is as follows: [...]

Inspectors wroteBased on record review, observation, and interview during the recertification survey on 9/7/2023 through 9/14/2022, the facility did not ensure each resident was treated with respect and dignity in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, in 2 (2 North and 2 South), of 2 dining rooms and 1 (Resident #3) observed. Specifically, residents in the 2 North and 2 South dining rooms waited for up to 31 minutes after their dining mates were served, for their meals to be served and for Resident #3, personal care was provided with an opened door, exposing the resident to anyone in the hallway.

Inspectors wroteBased on observation and interview during a recertification and abbreviated survey conducted on 9/7/2023 to 9/14/2023, the facility did not ensure that the results of the most recent survey of the facility conducted by Federal or State surveyors and any plan of correction in effect with respect to the facility was posted in a place readily accessible to residents, and family members and legal representatives of residents, and did not ensure to post notice of the availability of such reports in areas of the facility that are prominent and accessible to the public. Specifically, the facility did not ensure that the residents and staff knew where the survey report was located. This was evidenced by: During a meeting with a group of 6 residents on 9/7/2023 at 3:01 PM, the residents stated they did not know where the survey report was located. [...]

Inspectors wroteBased on interviews and record reviews conducted during the recertification and abbreviated survey (Case #NY00298115) the facility did not ensure prompt efforts were made to file and resolve a grievance concerning missing items and did not take appropriate timely corrective action in accordance with State Law for 1 (Resident #116) of 1 resident reviewed for grievances. Specifically, for Resident #116, the facility did not ensure they promptly acknowledged the resident's complaint regarding missing hearing aids and did not promptly make attempts to resolve the complaint. This was evidenced by: A document titled Grievance/Concern Form dated 10/2016 and revised 5/2018, 9/2017, 1/2020, 3/19/2021, and 10/28/2021 documented the following; Policy: [...]

Inspectors wroteBased on record review and interview conducted during the recertification survey dated 9/7/2023 through 9/14/2022, the facility did not ensure the development of comprehensive person-centered care plans, that included measurable objectives and time frames to meet the resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment, for 2 (Resident #s 19 and #80) of 30 residents reviewed for comprehensive care plans (CCP). Specifically, for Residents #19 and #80, the facility did not ensure a CCP was developed to address the use of psychotropic medications and for Resident #80, did not ensure a CCP was person-centered. [...]

Inspectors wroteBased on observation, record review and interviews during a recertification survey on 9/7/2023 through 9/14/2023 the facility did not ensure residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for 1 (Resident #12) of 30 residents reviewed. Specifically, for Resident #12, the facility did not ensure physician ordered Silvadene 1% topical cream was applied twice daily to right knee wound along with border gauze dressing completed in accordance with the physician order and comprehensive care plan and did not ensure the physician was notified when the medication was not applied and dressing not completed. This is evidenced by: [...]

Inspectors wroteBased on observation, record review and interviews, during a recertification survey and an abbreviated survey (Case #NY00317162) the facility did not ensure the residents environment remained as free of accident hazards as is possible; and each resident receives adequate supervision and assistance devices to prevent accidents in accordance with professional standards of practice, and the comprehensive person-centered care plan or 1 (Resident #214) of 30 residents reviewed. Specifically, for Resident #214 the facility did not ensure preparation of heated soup temperature was tested and served at a safe temperature resulting in a first degree burn to the resident's bilateral groin, blistering on their right hand and right thigh area. This is evidenced by: [...]

Inspectors wroteBased on observation, interview, and record review conducted during a Standard survey completed 9/14/2023, the facility did not provide food and drink that were prepared by methods that conserved flavor, and appearance, were palatable and at a safe and appetizing temperature, for 3 (Units 1, 2 South, and 2 North) of 3 units. Specifically, food and beverages were served at suboptimal temperatures and were not palatable. Additionally, food temperatures were not obtained prior to serving meals.

Inspectors wroteBased on observation and interviews during the recertification survey dated 09/07/2023 through 09/14/2023, the facility did not dispose of garbage and refuse properly. Specifically, the dumpster cover was open exposing kitchen food waste stored within, the cover was heavily soiled with black grime, and the grounds around the dumpster were littered. This was evidenced as follows: During observations on 09/07/2023 at 11:08 AM, the dumpster cover was open exposing kitchen food waste stored within, the cover was heavily soiled with black grime, and the grounds around the dumpster were littered. During an interview on 09/07/2023 at 11:08 AM, the Director of Dietary Department stated that kitchen staff should have both kept the dumpster closed after filling and the litter picked up. [...]

Inspectors wroteBased on observation, interview, and record review during a recertification survey the facility did not ensure pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) were provided to meet the needs of each resident for 2 (Resident #'s 53 and #57) of 4 residents reviewed. Specifically, for Resident #53, the facility did not ensure a medication prescribed to treat diabetic neuropathy was available to administer three times per day, and for Resident #57, the facility did not ensure nursing administration was notified when a physician's order to renew the resident's narcotic pain medication did not arrive from pharmacy and was not available for administration. This was evidenced by: Resident #53: [...]

Inspectors wroteBased on observation, interview, and record review during a recertification survey, the facility did not ensure the resident or the resident's representative was informed and provided written information regarding advance directive information nor was an dvance directive formulated for 1 (Resident #51) of 2 residents reviewed for Advance Directives. Specifically, for Resident #51, the facility did not ensure Advance Directives or code status of the resident was addressed upon admission or during the resident's nursing home stay. This was evidenced by: Resident #51: Resident #51 was admitted with diagnoses of unspecified dementia with behavioral disturbance, type 2 diabetes mellitus and thrombocytopenia. The Minimum Data Set (MDS-an assessment tool) dated 5/08/2021, documented the resident was cognitively intact. The resident was able to understand others and to be understood by others. [...]

Inspectors wroteBased on observation, manufacturer's directions review, and staff interview during the recertification survey, the facility did not store, prepare, distribute and serve food in accordance with professional standards for food service safety. The safe and sanitary operation of a professional kitchen is to include particular methods of operation. [...]

Inspectors wroteBased on record review and interview during the recertification survey, the facility did not ensure the policy regarding foods brought to residents is in accordance with adopted regulations. Specifically, the facility does not have a policy that includes a procedure to ensure all residents have the necessary assistance in accessing and consuming food brought to them by visitors, and the facility does not provide information for family and other visitors on safe food handling practices or safe reheating of food that is brought in to residents. This is evidenced is as follows. The facility policy for food brought in by visitors was reviewed on 06/15/2021. This policy states that the Dietary Manager will give information to family and visitors on proper food handling to promote food safety. [...]

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 7 (Residents #'s 1, 9, 21, 47, 53, 106 and #455) of 24 residents reviewed for baseline care plans. Specifically: For Resident #'s 1, 9, 21, 47, 53, and 106 the facility did not ensure the written summary of the baseline care plan was provided to the resident and/or resident representative; For Resident #455, who had a diagnosis of pneumonia, the facility did not ensure a baseline care plan was developed to address the resident's respiratory needs and that a summary was reviewed with the resident and/or residents' representative within 48 hours of admission. [...]

Inspectors wroteBased on observation and staff interview during the recertification survey the environment was not free from accident hazards over which the facility has control. Specifically, resident room wardrobes on 3 of 3 units were not secured from toppling. This is evidenced as follows. A selection of resident rooms on the First Floor, Second Floor North, and Second Floor Units were inspected on 08/08/2019 at 10:15 AM. The wardrobes in resident room #'s 125, 141, 210, 233, and #242 were free-standing and could topple over when tested with normal body weight. The Director of Maintenance stated in an interview on 08/08/2019 at 10:00 AM, that he understands that the unsecured wardrobes in resident rooms could cause an accident, and he will secure all the wardrobes to the wall. 10 NYCRR 415.12(h)(1)

Inspectors wroteBased on observation, interview and record review during 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 infections determined for 2 (Resident #'s 15 and 87) of 2 residents. Specifically, the facility did not ensure standard precautions were maintained during a dressing change for Residents #'s 15 and 87. This is evidenced by: Resident #15: The resident was admitted on [DATE], with diagnoses of multiple sclerosis, epilepsy and unspecified convulsions. The Minimum Data Set (MDS) dated [DATE], documented the resident was moderately impaired for cognition, understood others and was usually understood by others. A Policy and Procedure for Non-Sterile Dresssing Change dated 08/2016 documented: - Prepare/open dressing item on the table. [...]

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 3 (Resident's #13, 67, and #305) of 3 residents reviewed for Beneficiary Protection Notification. Specifically, for Resident #'s 13 and #67, the facility did not ensure the residents' or the residents' representatives were informed of the beneficiary's potential liability for payment and related standard claim appeal rights using the Skilled Nursing Facility Advance Beneficiary Notice (SNFABN), form CMS-10055. [...]

Inspectors wroteBased on record reviews and interviews during the recertification survey the facility did not ensure that residents and/or resident's representatives were notified in writing of the reason for the transfer/discharge to the hospital in a language they understand for two (Resident #21 and #455) of two residents reviewed for hospitalization. Specifically, for Resident #'s 21 and #455, the facility did not provide written notice of transfer/discharge to the residents and/or residents' representatives when the residents were transferred to the hospital, and the facility did not send a copy of the discharge notice to a representative of the Office of the State Long-Term Care Ombudsman. This is evidenced by: Resident #21: The resident was admitted to the facility on [DATE] with the diagnoses of chronic obstructive pulmonary disease (COPD), rheumatoid arthritis (RA), and diabetes mellitus (DM). [...]

Inspectors wroteBased on record reviews and interviews during the recertification survey, the facility did not ensure two (Resident #21 and #455) of two residents reviewed for hospitalization received a bed hold policy notice upon transfer. Specifically, for Resident #'s 21 and #455, the facility did not ensure that the residents and/or the residents' representatives were notified in writing of the bed hold policy when the resident was transferred to the hospital. This is evidenced by: Resident #21: The resident was admitted to the facility on [DATE], with the diagnoses of chronic obstructive pulmonary disease (COPD), rheumatoid arthritis (RA), and diabetes mellitus (DM). The Minimum Data Set (MDS- an assessment tool) dated 6/12/19, documented the resident was cognitively intact and was able to make self understood and understand others. [...]

Inspectors wroteBased on observation, record review and interviews during the recertification survey the facility did not ensure comprehensive care plans (CCP) were reviewed and revised as necessary for 3 of 24 residents reviewed. Specifically, Resident #9's care plan was not revised after the diiscontinuation of an anticoagulant medication, Resident #47's careplan was not revised io include the resident's current level of assistance for care, and Resident #53's careplan was not revised to include interventions post fall. This was evidenced by: Resident #9: The resident was admitted to the facility on [DATE], with the diagnoses of dementia, anxiety and right humeral and femoral fracture. The Minimum Data Set (MDS-an assessment tool) dated 8/7/19, documented the resident was cognitively intact and was sometimes able to make herself understood and usually able to understand. [...]

Inspectors wroteBased on record review and interviews, the facility did not ensure that each resident's drug regimen was free from unnecessary drugs, which was any drug used in excessive dose, for excessive duration, without adequate monitoring, without adequate indications for its use, or in the presence of adverse consequences which indicated the dose should be reduced or discontinued for 1 (Resident #66) of 1 resident reviewed for anticoagulation medication. Specifically, for Resident #66, the facility did not ensure a physician order for Heparin injections (anticoagulation medication) had an adequate indication for use and did not ensure the resident was free from adverse, uncomfortable or unpleasant, consequences related to the administration of the injections which resulted in the resident's refusal of the medication. This is evidenced by: Resident #66: [...]

Inspectors wroteBased on observation and staff interview during the recertification survey, the facility did not store, prepare, distribute or serve food in accordance with professional standards for food service safety. Food preparation and serving areas are to be kept clean. Specifically, the ceiling and the exhaust fan guards in the main kitchen were not clean. This is evidenced as follows. The main kitchen was inspected on 08/08/2019 at 8:35 AM. The ceiling tiles by the exhaust hood were heavily soiled with grease. The exhaust fan guards over the grill line were covered in a slight buildup of grease and one guard was missing. The Director of Food Service stated in an interview on 08/08/2019 at 10:35 AM, that the ceiling tiles in the kitchen are extremely greasy and should be replaced. [...]