Menorah Home & Hospital for Aged & Infirm

Inspectors wroteBased on observation, record review, and interviews conducted during an abbreviated survey (625460), the facility did not ensure that each resident received adequate supervision to prevent accidents. This was evident for one (1) of two (2) residents (Resident #1) sampled for Injuries of Unknown Origin. Specifically, on 01/06/2024 at 5:45 AM, Resident #1 reported to Home Health Aide #1 that they had pain to their right hip. Resident #1 was assessed by Registered Nurse #1 at 8:23 AM and was observed with their right leg swollen and larger than the left. Resident #1 was transferred to the hospital at 10:25 AM and was diagnosed with an acute traumatic comminuted right femoral intertrochanteric fracture (a break in the thigh bone) with superior displacement of the femoral head (broken hip). [...]

Inspectors wroteBased on observation, record review, and interviews conducted during an abbreviated survey (625460), the facility failed to ensure sufficient nursing staff were available to provide nursing services to attain or maintain the highest practicable physical, mental, and psychosocial wellbeing for each resident. This was evident for one (1) of five (5) residents (Resident #1) sampled. Specifically, on 01/06/2024 at 5:45 AM, Resident #1 complained of pain to their right hip and was assessed by Registered Nurse #1 at 8:23 AM and was observed with swelling to their right leg that was larger than the left. Resident #1 was transferred to the hospital at 10:25 AM on 01/06/2024 and was diagnosed in the hospital with an acute traumatic comminuted right femoral intertrochanteric fracture (a break in the thigh bone) with superior displacement of the femoral head (broken hip). [...]

Inspectors wroteBased on observation, record review, and interviews conducted during an abbreviated survey (625460), the facility failed to ensure a facility-wide assessment to determine what resources were necessary to care for its residents competently during both day-to-day operations and emergencies. The facility must review and update that assessment, as necessary, and at least annually. The facility must also review and update this assessment whenever there is, or the facility plans for, any change that would require a substantial modification to any part of this assessment. The facility did not consider specific staffing needs for each resident and adjust as necessary based on any changes to its resident population. This was evident during review of Staffing from 01/01/2024 - 01/06/2024. [...]

Inspectors wroteBased on observation, record review, and interviews conducted during an abbreviated survey (NY00331104), the facility failed to ensure pain management was provided to a resident who requires such services, consistent with professional standards of practices, the comprehensive person-centered care plan, and the residents' choices. This was evident in one (1) of two (2) residents (Resident #1) sampled. Specifically, on 01/06/2024 at 5:45 AM, Resident #1 reported to Home Health Aide #1 that they had pain to their right hip. Home Health Aide #1 reported the pain to Licensed Practical Nurse #1 who instructed them to wait for the incoming shift. Licensed Practical Nurse #1 did not immediately check on Resident #1 and the resident was not immediately assessed by a Registered Nurse. [...]

Inspectors wroteBased on observation, record review, and interviews during an abbreviated survey (NY 00328412), the facility did not ensure that all residents received the necessary care to attain or maintain the highest practicable physical, mental, and psychosocial well-being, consistent with the resident's comprehensive assessment and plan of care. This was evident in two out of three residents sampled (Resident #1 and Resident #2). Specifically, on 11/16/2023, Resident #1 reported to Registered Nurse Supervisor #1 they requested pain medication at 7:30 PM and did not receive it. Resident #2 informed Registered Nurse Supervisor #1 they received some medication at 5:00 PM on 11/16/2023 but did not receive the blue tablet (sleeping medication). [...]

Inspectors wroteBased on observation, record review, and interviews during an abbreviated survey (NY00320606), the facility failed to protect a resident's right to be free from physical abuse by a nursing home staff. This was evident in one out of three residents sampled for abuse (Resident #1). Specifically, on 07/22/2023 at approximately 8:50 PM, Resident #1 told Registered Nurse #1 that Certified Nursing Assistant #1 threw them in the bed from the wheelchair and they hit their head on the headboard. Resident #1 was assessed by Registered Nurse #1 and there were no visible injuries. This resulted in Past Noncompliance with no potential for serious harm.

Inspectors wroteBased on observations, record review, and staff interviews conducted during the Recertification Survey from 10/8/2024 to 10/16/2024, the facility did not ensure that the survey results were posted in a place readily accessible to residents, visitors, or legal representatives where individuals wishing to examine survey results do not have to ask to see them. Specifically, the survey results were located inside a binder placed behind a glass partition at the Security desk. The finding is: The facility policy and procedure titled Right to Survey Results, reviewed 11/22/2023, documented that the facility will ensure that the resident has the right to examine the results of the most recent survey of the facility conducted by Federal or State surveyors and any plan of corrections in effect with respect to the facility. The Facility must: [...]

Inspectors wroteBased on record review and interview conducted during the Recertification survey conducted from 10/08/2024 to 10/16/1024, the facility did not ensure they provided the appropriate liability and appeal notice to Medicare beneficiaries at the termination coverage. This was evident for 1 (Resident #404) of 3 residents reviewed for Beneficiary Notification. Specifically, the Notice of Medicare Non-Coverage was not mailed out to Resident #404's designated representative on the same day that telephone notification was made.

Inspectors wroteBased on record reviews and interviews conducted during the Recertification survey from 10/8/2024 to 10/16/2024, the facility did not ensure that comprehensive care plans were developed and implemented to meet each resident's needs. This was evident for 1 (Resident # 64) of 5 residents reviewed for Unnecessary Medications. Specifically, a care plan for use of anticoagulant medication was not developed for Resident #64.

Inspectors wroteBased on observation, interviews, and record reviews conducted during the Recertification and Complaint (NY00317447) survey from 10/08/2024 to 10/16/2024, the facility did not ensure resident's person-centered, Comprehensive Care Plans were reviewed and revised with each assessment and as needed to reflect the resident's changing needs. This was evident for 1 (Resident #389) of 5 residents reviewed for Unnecessary Medication, and 1 (Resident 84) of 4 residents reviewed for Abuse out of an investigative sample of 38 residents. Specifically, the Psychoactive Drug Use Comprehensive care plan for Resident #389 was not reviewed or revised after each assessment, and Risk for Victimization Comprehensive care plan for Resident # 84 was not review or revised after annual or quarterly assessments.

Inspectors wroteBased on observations, record review, and staff interviews conducted during the Recertification survey between 10/08/2024 and 10/16/2024, the facility did not ensure that needed services, care and equipment are provided to assure that residents with limited range of motion and mobility maintain or improve function based on the residents' clinical condition. This was evident for 1 out of 3 residents reviewed for Position and Mobility, (Resident #382) out of 38 sampled residents. Specifically, Resident #382 had an order to apply bilateral splints to resident's hands to be worn at all times and was observed on multiple occasions without the device in place as per Physician's order.

Inspectors wroteBased on record review and interviews conducted during the Recertification and Complaint Survey (NY00343354) from 10/8/2024 to 10/16/2024, the facility did not ensure that all alleged violations involving abuse were reported immediately, but not later than 2 hours after the allegation was made, to the State Survey Agency in accordance with State law through established procedures. This was evident for 1 (Resident #357) of 4 residents investigated for Abuse out of an investigative sample of 38 total residents. Specifically, the facility received a report that Resident #357 was allegedly missing cash totaling approximately $900 and did not report to the New York State Department of Health in a timely manner.

Inspectors wroteBased on interviews and record review conducted during a Recertification and Complaint survey (NY00328780) from 10/08/2024 to 10/16/2024, the facility failed to ensure each resident received adequate supervision to prevent elopement. This was evident for 1 (Resident #369) of 3 residents investigated for Accidents out of an investigative sample of 38 residents. Specifically, on 11/23/2023, Resident #369 who was not identified as a high risk for elopement, was able to exit the front doors of the facility and walk down to the guard booth where Resident#369 was then redirected and taken back into the facility.

Inspectors wroteBased on observation, record review, and interviews conducted during an abbreviated survey (NY00337987), the facility failed to adequately supervise a resident to prevent accidents. This was evident in 1 out of 3 residents sampled (Resident #1). Specifically, on 04/02/2024 at 2:20 pm, during recreational social hour in the dining room, Resident #1, accidentally spilled hot tea on their person. Subsequently, Resident #1 was assessed to have redness to two areas on the left side of the lower abdomen and left upper inner thigh. This resulted in actual harm to Resident #1 that was not immediate jeopardy.

Inspectors wroteBased on observations, record review, and interviews conducted during the Recertification and Complaint survey, the facility did not ensure safe food storage was practiced to prevent food-borne illness. This was evident during the initial tour of the Kitchen. Specifically, expired enteral feed nutritional supplement was observed in the Kitchen's emergency food supply storage area.

Inspectors wroteBased on record review and interview conducted during the recertification survey, the facility did not ensure a person-centered comprehensive care plan (CCP) was developed to meet a resident's medical, nursing, mental, and psychosocial needs that are identified in the comprehensive assessment. This was evident for 1 (Resident #31) of 38 sampled residents. Specifically, Resident #31's Dementia CCPs were not person-centered and did not include interventions to address Resident #31's Dementia-related behavioral symptoms of hitting, spitting, and scratching during care.

Inspectors wroteResident #31 Dementia Care Based on observations, interviews and record review conducted during a recertification survey, the facility did not ensure residents' comprehensive care plan (CCP) was reviewed and revised after each assessments. This was evident for 2 resident (Resident #31 and Resident #246) of 38 sampled residents. Specifically, Resident #31 diagnosis with Dementia, had a CCP in place with one intervention that was not revised to address the Resident #31's medical, physical, mental, and psychosocial needs, and had no non-pharmacological interventions to address the residents' behaviors. 2) Resident #246 CCP was not reviewed and revised to address recommendations to remove hoyer lift canvas when out of bed to prevent friction and skin breakdown.

Inspectors wroteBased on record review and interview conducted during the Recertification Survey from 8/25/22 to 09/02/22, the facility did not ensure a resident with mobility issues received treatment and care in accordance with the Comprehensive Care Plan (CCP). This was evident for 1 (Resident #246) of 1 resident reviewed for Pressure Ulcer (PU) out of a sample of 39 residents. Specifically, Resident #246 had contractures and required assistance with Activities of Daily Living and did not have hoyer lift canvas removed when out of bed in accordance with OT recommendations to prevent skin friction.

Inspectors wroteBased on observations, interviews, and record review conducted during the Recertification Survey from 8/25/22 to 09/02/22, the facility did not ensure a resident at risk for pressure ulcer (PU) received appropriate treatment and services to prevent future PU. This was evident for 1 (Resident #246) of 1 resident(s) reviewed for PU/Injury out of 39 total sampled residents. Specifically, Resident #246 was observed on multiple occasions sitting on a hoyer lifter canvas after Occupational Therapy (OT) recommended hoyer lift canvas be removed to prevent friction.

Inspectors wroteBased on observations, interviews, and record review conducted during the recertification survey from 8/25/22 to 9/2/22, the facility did not ensure a resident diagnosed with dementia, received the appropriate treatment and services to attain or maintain their highest practicable physical, mental, and psychosocial well-being. This was evident for 1 (Resident #31) of 1 resident(s) reviewed for Dementia Care out of a sample of 38 residents. Specifically, a Comprehensive Care Plan (CCP) related to Dementia was not individualized and revised with person-centered intervention to address Resident #31's diagnosis of dementia cognitive loss.

Inspectors wroteBased on record review and interviews conducted during the Recertification survey from 8/25/22 to 9/2/22, the facility did not ensure the Minimum Data Set 3.0 (MDS) assessment was transmitted to the Center for Medicare and Medicaid Services (CMS) within 14 days of completion. This was evident for 2 (Resident #4 and #5) of 16 residents for Resident Assessment out of 39 sampled residents. Specifically, MDS assessments for Resident #4 and Resident #5 were not submitted to CMS within 14 days of completion.

Inspectors wroteBased on observation and interview conducted during the recertification survey, the facility did not ensure a resident is free from physical restraint. Specifically, a resident was observed sitting on a wheel chair with a chair alarm attached to the back of the resident's clothes. The resident complained to the State Agent (SA) that the alarm preventing her from moving around. In addition, there was no documentation in the clinical record that the chair alarm was being used for this resident. This was evident for 1 of the 2 residents reviewed for Physical Restraints out of a sample of 38 residents (Resident #249). The finding is: The facility policy, titled Restraints dated 9/1/07 documented the following: [...]

Inspectors wroteBased on observation, record review, and interview during the recertification survey, the facility did not ensure that the Minimum Data Set (MDS) assessment accurately reflect the resident's status. Specifically, the admission assessment for a resident admitted to the facility with hospice care did not reflect hospice. This was evident for 1 of 1 resident reviewed for Hospice out of a total sample of 38 residents (Resident #249).