Highlands Living Center

Inspectors wroteThe findings include:The facility policy Abuse, Neglect, and Mistreatment Prohibition, Investigation and Reporting, last reviewed April 2025, included the facility shall investigate and report any injury of unknown source immediately or within two (2) hours to the Department of Health. Resident #2 had diagnoses including dementia, pulmonary fibrosis (lung disease that occurs when lung tissue becomes damaged or scarred), and anxiety. The Minimum Data Set (resident assessment tool) dated 09/24/2025 revealed Resident #2 had moderate cognitive impairment and had one (1) fall with major injury (such as bone fractures) since the prior assessment. Review of Resident #2's Comprehensive Care Plan and Kardex (care plan used by certified nursing assistants to direct care), last revised 07/28/2025, revealed Resident #2 was independent with a four (4) wheeled walker for ambulation (walking). [...]

Inspectors wroteBased on interviews and record review, the facility failed to ensure an alleged violation involving a resident-to-resident altercation resulting in a serious injury was thoroughly investigated for one (1) of seven (7) residents reviewed (Resident #2). Specifically, Resident #2 sustained a right femoral neck fracture (hip fracture) requiring hospitalization and surgical intervention following a resident-to-resident altercation, and the facility failed to conduct a thorough investigation after the fracture was identified.

Inspectors wroteBased on observations, interviews and record reviews conducted during the Recertification Survey 02/11/2025 to 02/19/2025, the facility did not ensure all alleged violations of abuse, neglect, or mistreatment were thoroughly investigated for 7 (Resident #1, #47, #63, #77, #80, #81, and #103) of 12 residents reviewed. Specifically, Resident #1, Resident #47, Resident #63 and Resident #77 had injuries of unknown origin, and the facility was unable to provide documented evidence that potential abuse, neglect or mistreatment were appropriately ruled out via a thorough investigation. Resident #80 had an acute medical incident requiring medication that was not available, and the facility was unable to provide a complete investigation to rule out neglect. [...]

Inspectors wroteBased on observations, interview, and record review conducted during the Recertification Survey from 02/11/2025 to 02/19/2025, for two (first and third floors) of three resident-use floors, the facility did not properly maintain the resident call system. Specifically, nurse call system lights were not functioning properly to allow residents to call for staff assistance through a communication system which relays the call directly to a staff member or to a centralized work area from each resident's bedside and toilet/bathing facilities.

Inspectors wroteBased on observations and interview conducted during the Recertification Survey from 02/11/2025 to 02/19/2025, for three (first, second and third floors) of three resident-use floors, the facility did not provide a functional and sanitary environment for residents and staff. Specifically, handwash sinks were not provided with hot water, a handwash sink was not functional, and resident stand assist lift footrests were dirty.

Inspectors wroteBased on observations, interviews, and record review conducted during the Recertification Survey from 02/11/2025 to 02/19/2025 the facility did not ensure that person-centered comprehensive care plans were developed and/or implemented to address the resident's medical, physical, mental, and psychosocial needs for three (Residents #27, #81 and #108) of 25 residents reviewed. Specifically, Resident #27 was receiving oxygen per physician orders. The Comprehensive Care Plan did not include the use of oxygen or appropriate interventions. Resident #81 had physician orders and was care planned for a right-hand splint that was not in use on multiple observations. Resident #108 had diagnoses of anemia, depression, and fractures, was incontinent of bladder and bowel and received pain and antidepressant medication. [...]

Inspectors wroteBased on observations, interviews and record review conducted during the Recertification Survey from 02/11/2025 to 02/19/2025, for one (Residents #81) of three residents reviewed, the facility did not ensure that residents who were dependent on staff for assistance received the necessary services to maintain grooming and personal hygiene. Specifically, Resident #81 did not receive assistance with nail care over an extended period of time. This is evidenced by the following: The facility policy Activities of Daily Living (ADLs) dated September 2024 included a minimum of once per week shower or tub bath (per resident preference), all refusals need to be documented and if continued, care planned. Nail care cleaning and trimming are to be completed on shower days. [...]

Inspectors wroteBased on observations, interviews, and record review conducted during the Recertification Survey from 02/11/2025 to 02/19/2025, for two (Resident #34 and #110) of six residents reviewed, the facility did not ensure a medication error rate of five percent or less. There were four medication errors for 32 opportunities resulting in a medication error rate of 12.5 percent. Specifically, during observations of medication administration, multiple enteric coated pills (coating that protects mediation from being dissolved in the stomach), an extended release medication (one that is released gradually over a specific duration), and a sustained action medication (one that is released over an extended period of time) all with pharmacy labels instructing 'Do Not Crush' on the packaging were crushed and administered. [...]

Inspectors wroteBased on observations, interviews, and record review conducted during the Recertification Survey from 02/11/2025 to 02/19/2025, the facility did not ensure the resident was free from significant medication errors for one (Resident #110) of six residents reviewed. Specifically, during an observation of medication administration, two cardiovascular medications were administered without evidence that vital signs were obtained prior to administration per physician orders and one medication was crushed prior to administration despite the pharmacy medication label that instructed 'do not crush' on it. This is evidenced by the following: [...]

Inspectors wroteBased on observation, interviews and record review conducted during the Recertification Survey 02/11/2025- 02/19/2025 the facility did not ensure they established and maintained an Infection 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 one (Resident #21) of one resident reviewed for wound care. Specifically, appropriate Personal Protective Equipment (PPE-gown, gloves, masks) was not worn by nursing staff during high contact activity (wound care) for Resident #21 who was on Enhanced Barrier Precautions (steps taken by the facility to prevent the transmission of infectious diseases). This is evidenced by the following: The facility policy Infection Communication Plan dated January 2025 documented: [...]

Inspectors wroteBased on observations, interviews, and record reviews conducted during Recertification Survey from 6/2/23 to 6/9/23, it was determined that for one (Resident #51) of two residents reviewed for food and nutrition, the facility did not ensure services were provided to maintain acceptable parameters of nutritional status. Specifically, the facility did not ensure Resident #51 was consistently offered assistance during meals. Additionally, the facility could not provide documented evidence of consistent meal monitoring despite significant weight loss. The finding is: Resident #51 had diagnoses including failure to thrive, dementia, and depression. The Minimum Data Set (MDS) assessment dated [DATE] documented that the resident was severely impaired cognitively, required set up assist to eat and that the activity only occurred twice in the 7-day look back period. [...]

Inspectors wroteBased on observations, interviews, and record review conducted during the Recertification Survey completed 6/2/23 to 6/9/23, it was determined that for one of one main kitchen, the facility did not store, prepare, distribute, and serve food in accordance with professional standards for food service safety. Specifically: two low-temperature mechanical dish machines did not maintain an acceptable sanitizer concentration on dishes after the final rinse, the temperature gauge on one mechanical dish machine was not functioning properly, and improper dish washing/drying procedures were observed.

Inspectors wroteBased on observations, interviews, and record review conducted during the Recertification Survey completed 6/2/23 to 6/9/23, it was determined that the facility did not ensure compliance with all applicable State codes. Specifically, the facility was not in compliance with Section 915 of the 2015 Edition of the International Fire Code as adopted by New York State, which requires the use of carbon monoxide detection in a building that has fuel-burning appliances.

Inspectors wroteBased on interviews and record review conducted during a Recertification Survey 6/2/23 to 6/9/23 the facility did not ensure that all resident Electronic Health Records (EHR) were accessible to the survey team. Specifically, the team did not have access to the EHR before the end of the first day of survey and experienced on-going access issues for the duration of the survey causing an unnecessary delay to the survey process. This is evidenced by the following: State Operations Manual Rev. 211, 02/3/23 included but not limited to: 1. In accordance with accepted professional standards and practices, the facility must maintain medical records on each resident that are complete, accurately documented, readily accessible, and systematically organized. 2. [...]

Inspectors wroteBased on observations, interviews, and record review conducted during the Recertification Survey 6/9/23- 6/16/23, it was determined that for one (Resident #3) of two residents reviewed for respiratory care, the facility did not provide specialized care needs for the provision of respiratory care in accordance with professional standard of practice, and the resident's care plan, goals, and preferences. Specifically, Resident #3 was receiving oxygen (O2) and the attached humidification bottle was observed empty on several observations. This is evidenced by the following: Review of the facility policy, Oxygen Therapy dated 2018 included humidification bottles and oxygen tubing must be dated, timed, and changed every three days. [...]

Inspectors wroteBased on observations, interviews and record reviews conducted during the Recertification Survey 6/2/23-6/9/23 it was determined that for one (Resident #33) of two residents reviewed for dental services, the facility did not provide or obtain routine dental services to meet the resident's needs, including assisting with appointments and transportation arrangements. Specifically, Resident #33 had not received any dental services since their admission, (approximately 11 months ago) to the facility. This is evidenced by the following: The facility policy, Dental Services, dated 2018 documented that dental services will be provided for each resident for a complete oral examination 7 days (no longer than 14 days after admission) by a Dentist. On admission, residents are asked to sign a consent or declination form for dental services. [...]

Inspectors wroteBased on interviews and record reviews conducted during the Recertification Survey, completed on 9/2/21, the facility failed to inform all residents and /or resident representatives by 5:00 p.m. the next calendar day following the occurrence of either a single confirmed infection of COVID-19, or three or more residents or staff with new-onset of respiratory symptoms occurring within 72 hours of each other. Specifically, the facility did not provide verbal or written notification to three (Residents #39, #69 and #73) of three residents or resident representatives reviewed that several residents at the facility tested positive for COVID-19 or when a resident suffered a Covid-19 related death. This is evidenced by the following: [...]

Inspectors wroteBased on observations, interviews, and record reviews conducted during the Recertification Survey, completed on 9/2/21, it was determined that for one (Unit 2) of two units on Transmission Based Precautions (TBP), 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 infectious diseases and COVID-19. Specifically, a phlebotomy technician did not wear required personal protective equipment (PPE) when providing resident care for two residents (Resident #100 and #99) on TBP. In addition, the phlebotomy technician did not change their gown when going between the two residents. This is evidenced by the following: The New York State Department of Health guidance, titled Health Advisory: [...]

Inspectors wroteBased on observations, interviews, and record reviews conducted during the Recertification Survey, completed on 9/2/21, it was determined that the facility did not post the daily nurse staffing information per the regulations. Specifically, the daily nurse staffing information was not maintained or posted daily for an extended period of time. This is evidenced by the following: During observations on 08/31/21 09:37 a.m., throughout the facility, the daily nurse staffing information was unable to be located on any floor or unit. When interviewed on 8/31/21 at 11:53 a.m., the staff member at the front entrance screening station stated they have never seen the staffing information. When interviewed on 8/31/21 at 11:55 a.m., the secretary at the front desk stated that they were unaware of any nurse staffing information sheet. [...]