King Street Home Inc

Inspectors wroteBased on observation, record review and interview conducted during a recertification survey from 3/23/26 - 3/30/26, the facility did not maintain an infection prevention and control program designed to prevent the development and transmission of communicable diseases and infection. Specifically, during a Norovirus (very contagious stomach virus that causes nausea, vomiting and diarrhea) outbreak on 4/11/2025, the facility did not ensure an infection surveillance plan based on facility assessment was implemented for the identification, containment and prevention of infections and did not complete and submit a Nosocomial Outbreak Reporting Application ([NAME]) report as requested by the New York State Department of Health (NYSDOH) on 04/16/2025; [...]

Inspectors wroteBased on observations, record review, and interviews during the recertification and abbreviated (2564447) surveys conducted 03/23/2026 - 03/30/2026, the facility did not ensure an appropriate discharge plan for one (1) of three (3) residents (Resident #30) reviewed for discharge. Specifically, Resident #30 was sent to the hospital for a medical condition and provided a discharge notice while hospitalized . The discharge was appealed, and the resident was not accepted back to the facility when medically cleared to return to the facility.

Inspectors wroteBased on interviews and record review during the recertification survey from 03/23/2026 to 03/30/2026, the facility did not ensure that a copy of the notice of transfer or discharge was sent to the State Long Term Care Ombudsman for one (1) of three (3) residents (Resident #30) reviewed for Hospitalization. Specifically, there was no documented evidence that a notice of transfer was sent to the New York State Ombudsman when Resident #30 was sent to the hospital on June 20, 2025.

Inspectors wroteBased on record review and interview during an abbreviated survey (NY00354758), the facility did not ensure residents were free from significant medication errors for 2 out of 3 residents (Resident #3, Resident #8) reviewed for medication. Specifically, (1) during Resident #3's discharge instruction on their medications with Registered Nurse #1 on 9/16/2024, their family representative alerted Registered Nurse #1 that two medications: Lexapro (an antidepressant) and Seroquel/Quetiapine Fumarate(anti-psychotic) were prescribed to the resident in error because the resident was never on those medications. Resident #3 had received the antidepressant (Lexapro 10 mg) from 9/4/2024 to 9/16/2024. Resident #3 also received the anti-psychotic (Seroquel 50 daily at bedtime) from 9/5/2024 to 9/16/2024; [...]

Inspectors wroteBased on record review and interviews during an abbreviated survey (NY00349278), the facility did not ensure the resident's legal representative was provided with a copy of the resident's medical records upon request and 2 working days advance notice to the facility for 1 out of 3 residents (Resident #1) reviewed for medical records. Specifically, Resident #1's legal representatives requested the medical records for Resident #1 via email to the facility administrative coordinator on 8/23/2024. Resident #1's legal representative did not receive requested medical records until 9/10/2024, twelve days after the request was received by the facility. In addition, review of the facility policy revealed it did not meet federal regulations

Inspectors wroteBased on record review, observations and interviews during an abbreviated survey (NY00349278) the facility did not ensure postings were in a form and manner accessible and understandable to residents, resident representatives a list of names, addresses (mailing and email), and telephone numbers of all pertinent State agencies and advocacy groups, such as the State Survey Agency, the State licensure office, adult protective services where state law provides for jurisdiction in long-term care facilities, the protection and advocacy network, home and community based service programs, and the Medicaid Fraud Control Unit; and a statement that the resident may file a complaint with the State Survey Agency concerning any suspected violation of state or federal nursing facility regulation, including but not limited to resident abuse, neglect, exploitation, misappropriation. [...]

Inspectors wroteBased on observations, record review, and interviews during an abbreviated survey (NY00349278), the facility did not ensure the results of the facilities most recent New York State Department of Health survey were posted in a place readily accessible to residents, and family/legal representatives of residents. The facility also did not have a posted notice of the availability of such reports in areas of the facility that are prominent and accessible to the public. Specifically, the surveyor did not observe any results posted anywhere in the facility regarding the most recent survey conducted by the New York State Department of Health.

Inspectors wroteBased on record review and interviews during an abbreviated survey (NY00349278), the facility did not ensure the residents right to personal privacy and confidentiality of his or her personal and medical records for 1 out of 3 residents (Resident #5) reviewed for confidentiality. Specifically, on 1/14/2025 Resident #1's representative requested medical records which they forwarded to Resident #1's physician. Resident #1's representative was informed by Resident #1's physician's office that they had received medical records for Resident #5 instead of Resident #1. The Administrative Coordinator stated Resident #5's care plans were sent to the physician office in error.

Inspectors wroteBased on observation, record review, and interviews during an abbreviated survey (NY00349278, NY00364670) , the facility did not ensure residents/resident representatives were notified through postings in prominent locations throughout the facility of the right to file grievances orally or in writing; the contact information of the grievance official with whom a grievance can be filed, a reasonable expected time frame for completing the review of the grievance; the right to obtain a written decision regarding his or her grievance; and the contact information of independent entities with whom grievances may be filed, that is, the pertinent State agency, Quality Improvement Organization, State Survey Agency or protection and advocacy system; [...]

Inspectors wroteBased on record review and interviews during an abbreviated survey (NY00349278) the facility did not ensure the Minimum Data Set assessment accurately reflected the resident's status for 1 out of 4 residents (Resident #1) reviewed for assessments. Specifically, review of Resident #1's Minimum Data Set assessments dated 8/21/2024, 9/30/2024 and 12/17/2024 revealed discrepancies regarding the resident's extremity impairments, use of assistive devices and functional abilities.

Inspectors wroteBased on record review and interviews during an abbreviated survey (NY00364670), the facility did not ensure a comprehensive person-centered care plan was implemented for 1 out of 3 residents (Resident #2) reviewed for care planning. Specifically, on 11/16/2024 Resident #4 was diagnosed with pneumonia and was ordered to start on antibiotic and oxygen therapy. Review of Resident #2's care plans revealed there were no care plans initiated for pneumonia, antibiotic use or oxygen use.

Inspectors wroteBased on record review and interviews during an abbreviated survey (NY00349278), the facility did not ensure the comprehensive care plan was reviewed and revised by the interdisciplinary team after each assessment, including both the comprehensive and quarterly review assessments for 1 out of 4 residents (Resident #1) reviewed for care planning. Specifically, Resident #1's comprehensive care plans for medication refusals, physical aggression, social needs and nutritional problems were not reviewed and revised with the quarterly Minimum Data Set completed on 12/17/2024.

Inspectors wroteBased on observation, record review and interviews during the recertification survey from 1/4/24 to 1/11/24, the facility did not ensure residents were free from physical restraints for 7 of 7 residents (#15, #7, #17, #40, #49, #226, #227) reviewed for physical restraints. Specifically, Residents #15, #7, #17, #40, #49, #226, and #227 were observed with bed or chair alarms and (1) thorough assessments and re-evaluations were not conducted to address the use of alarms, (2) the physician's order was not obtained to address the medical symptoms that may warrant the use of the device, and (3) there was no evidence of consent for the use of the device.

Inspectors wroteBased on observation, record review and interviews conducted during the Recertification survey from 1/4/24 to 1/11/24, the facility did not ensure proper storage, preparation, distribution, and service of food in accordance with professional standards for food safety. Specifically, 1) opened, undated, unlabeled, and/or expired foods were stored in two (2) refrigerated units and one (1) freezer unit; and 2) the concentration of quaternary ammonium compound chemical sanitizing rinse (QAC) was less than required by the manufacturer to ensure sanitization of food preparation and service equipment.

Inspectors wroteBased on observation, record review, and interview during the Recertification survey from 1/4/24 to 1/11/24, the facility did not ensure did not ensure that the call bell system was accessible for 1 of 1 residents (Resident #7) reviewed for Accidents. Specifically, Resident #7, who had a history of falls and was assessed to be at high risk for falls, was observed without their call bell within reach as per their plan of care.

Inspectors wroteBased on record review and interviews conducted during the Recertification survey from 1/4/24 to 1/11/24, the facility did not ensure for 1 of 3 residents reviewed for hospitalization (Resident #43) that the resident or the resident's representative was given a timely written notice of the facility's bed hold policy upon transfer to the hospital. Specifically, Resident #43 was transferred to the hospital and the facility could not provide evidence that a written notice of the facility Bed Hold Policy was provided to the resident or the resident's representatives.

Inspectors wroteBased on observation, record review, and interviews conducted during the Recertification survey from 1/4/24 to 1/11/24, the facility did not ensure that resident Minimum Data Set assessments (MDS-an assessment tool) accurately reflected the resident's status. This was evident for 7 of 7 residents (Residents #7, #17, #21, #227, #15, #40, #49) reviewed for Minimum Data Set accuracy. Specifically, 1) the Minimum Data Set assessments for Residents #7, #17, #227, #15, #40, and #49 documented alarms not used although alarms were observed in use and were documented on the Certified Nurse Aide Care Guides for the residents, and 2) the Minimum Data Set assessment for Resident # 21 documented the presence of one or more pressure ulcer/injury but documented the current number of unhealed pressure ulcers/injuries at each stage as zero.

Inspectors wroteBased on observation, record review and interviews conducted during the Recertification survey from 1/4/24 to 1/11/24, the facility did not ensure Preadmission Screening (SCREEN) was complete for 2 of of 24 (Residents #220 and #224) residents reviewed. Specifically, for Residents #220 and #224, the facility did not ensure the SCREEN form DOH-695 included answers to the questions regarding Mental Retardation/Developmental Disability.

Inspectors wroteBased on observation, record review and interviews conducted during the Recertification survey from 1/4/24 to 1/11/24, the facility did not ensure for 2 of 3 residents (#15, #43), reviewed for care planning, that each resident and resident representative, if applicable, was involved in developing the care plan and making decisions about his or her care. Specifically, Residents #15 and #43's resident representatives expressed interest in attending care planning meetings and reported they had not been invited for six months and one year, respectively.

Inspectors wroteBased on staff interview and review of facility records during the Recertification survey from 1/4/2024 to 1/11/2024, the facility did not ensure certified nurse aides (CNAs) performance reviews were completed at least once every 12 months. Specifically, six of ten randomly selected CNAs (staff #22, #23, #24, #27, #28, #30) did not have a performance reviews documented at least once every 12 months.

Inspectors wroteBased on record reviews, observations and interviews during a Recertification Survey, it could not be ensured that the facility promoted the right to participate in the development and implementation of person-centered plans of care, including but not limited to the right to participate in the planning process and attend care planning meetings. This was evident for 1 of 2 residents (Residents #13) reviewed for care planning. Specifically, Resident #13 has not participated in the planning process and has not participated in a care planning meeting.

Inspectors wroteBased on observations, record reviews and interviews during the Recertification Survey, it could not be ensured that the facility consistently implemented Comprehensive Person-Centered Care Plan (CCP) for each resident. This was evident for 1 of 1 resident (Resident #28) reviewed for accidents and 1 of 3 residents reviewed for Pressure Ulcers (PUs). Specifically, 1) Resident #28 was not consistently monitored at 15-minutes intervals for 9 of 11 days reviewed and, 2) Resident #28 was observed without the chair alarm in place and 3) Resident #38 did not have a CP in place to address a stage 4 PU.

Inspectors wroteBased on record reviews and interviews conducted during a Recertification Survey, it could not be ensured that the facility provided timely written notification of a transfer in a language and manner they could understand to a resident or their representative/s. This was evident for 1 of 2 residents reviewed for hospitalization. Review of the facility's Transfer and Discharge policy which was updated in June 2020 documented that before the facility transfers or discharges a resident, the facility will provide written notice to the resident and/or their representative/s in a manner and language in which they can understand. The finding is: Resident #48 was an [AGE] year-old male admitted to the facility on [DATE] with diagnoses including Fracture of Nasal Bones, Muscle Weakness and Atrial Fibrillation. The admission Minimum Data Set (MDS; [...]

Inspectors wroteBased on interviews and record reviews conducted during a Recertification Survey, it could not be ensured that the facility provided written notice of the facility's Bed Hold policy to residents and their representative/s at the time of transfer. This was evident for 1 of 2 residents (Resident #48) reviewed for admission/transfer/discharge. The facility policy for Bed Holds and Returns, revised June 2020 states that prior to transfers and therapeutic leaves, residents or residents' representative/s will be informed in writing of the Bed Hold and Return policy. The finding is: Resident #48 was an [AGE] year-old male admitted to the facility on [DATE] with diagnoses including Fracture of Nasal Bones, Muscle Weakness and Atrial Fibrillation. The admission Minimum Data Set (MDS; [...]

Inspectors wroteBased on record review and interview conducted during a recertification survey, the facility did not ensure that it completed a risk assessment or that its potable water system was tested, as required by public health laws and regulations, to determine the presence of Legionella and/or other opportunistic waterborne pathogens, that could grow and spread in the facility's water system and affect the health of the residents, staff, and visitors. Legionella can cause a serious type of pneumonia in persons at risk. Outbreaks have been linked to poorly maintained water systems in buildings with large or complex water systems including long-term care facilities. The Public Health Law Section 225(5)(a) Subpart 4-2.4 Sampling and Management Plan states that all covered facilities shall adopt and implement a Legionella culture sampling and management plan for their potable water systems.

Inspectors wroteBased on observation interview and record review conducted during a recertification survey, the facility did not ensure for 1 of 1 resident (#54) reviewed for tube feeding that the necessary care was provided to ensure sufficient fluid intake in accordance with the physician's order for this resident assessed as at risk for fluid and electrolyte imbalance and ensure that the resident received the prescribed amount of feeding.

Inspectors wroteBased on interview and record review conducted during the most recent recertification survey, the facility did not ensure that 1 of 3 residents ( #13) reviewed for bowel regularity was provided the appropriate treatment based on comprehensive person-centered care plan. Specifically, the facility did not consistently implement the plan of care as it related to monitoring and recording the frequency of the resident's bowel movements (BM) and did not implement the physician's orders (or bowel protocol) as written consistently to ensure bowel regularity. The finding is: Resident #13 has diagnoses of Dementia and Depression. The admission Minimum Data Set (a resident assessment tool) of 8/10/18 documented that the resident has severely impaired cognitive skills for daily decision making; was totally dependent on two persons for assistance with toilet use and personal hygiene; [...]

Inspectors wroteBased on interview and record review conducted during a recertification survey, the facility did not ensure that each medication prescribed for 1 of 5 residents (#7) reviewed for unnecessary medications continued to be necessary. Specifically, the nursing staff did not promptly inform the resident's physician of potential adverse effects of two medications in order for the physician to determine if the medications should be continued or reduced. The finding is: Resident #7 has diagnoses of Dementia, Congestive Heart Failure (CHF), and Diabetes Mellitus. The November 2018 physician's orders included Divalproex (Depakote) 125 mg daily for mood disorder and Furosemide (Lasix; a diuretic) 80 mg daily for CHF. The care plan for hydration dated 11/15/18 noted that the resident had the potential for fluid deficit related to diuretic use. [...]

Inspectors wroteBased on observation, interview and record review conducted during a recent recertification survey, the facility did not ensure that its medication error rate did not exceed 5%. This was evident for 2 of 4 residents (# 334 and # 335) observed during a medication pass, for a total of 2 out of 27 opportunities for error resulting in an error rate of 7.4%.

Inspectors wroteBased on record review and interview conducted during a recertification survey, the facility did not ensure for 2 of 2 residents (#32 and #59) reviewed for hospitalization that residents or their representatives received written notice of discharge and the reason for transfer for the move in a language and manner they understood. Specifically, the facility did not ensure that written notifications of discharge were provided to the residents and/or their representives. Additionally, the facility did not ensure that a copy of discharge notice was sent to the Office of the State Long-Term Care Ombudsman.