Niagara Rehabilitation and Nursing Center

Inspectors wroteBased on observations, interviews, and record review conducted during the survey the facility failed to maintain an effective pest control program for the Main Kitchen and one (1) of three (3) resident floors. Issues included observations of rodent droppings in the dry storage room of the main kitchen, and complaints of rodent sightings in the main kitchen, resident rooms and halls. Additionally, on the exterior of the building, garbage and the contents of the kitchen grease traps, were stored in a manner that had the potential to attract rodents. Residents #3, 25, 47, 63, 65, 80, 94, 97, and #115 were involved.

Inspectors wroteBased on observation, interview, and record review conducted during an Abbreviated survey completed on 12/30/24 (Complaint # NY00312953) the facility failed to protect a resident from sexual abuse for one (Resident #1) of three residents reviewed. Specifically, Resident #1 received explicit sexual text messages and a nude picture from a facility Housekeeper #1. The finding is: The policy titled Abuse, Neglect, Exploitation or Misappropriation Reporting and Investigation dated 9/2022 documented all reports of resident abuse, neglect, exploration or theft of a resident property are reported to local, state, and federal agencies (as required by current regulations) and thoroughly investigated by facility management. Findings of all investigations are documented and reported. [...]

Inspectors wroteBased on observation, interview, and record review conducted during an Abbreviated survey (Complaint #NY00354751), the facility did not ensure any individual working in the facility as a nurse aide on a full time basis for more than 4 months was competent to provide nursing and nursing related services and that individual has completed a training and competency evaluation program or a competency evaluation program approved by the State meeting the requirements for two (certified nurse aide trainee #1 and #2) of seven staff members reviewed for training. Specifically Certified Nurse Aide Trainee #1 and #2 had been employed by the facility and functioned in the role of a nurse aide for greater than 4 months without receiving a nurse aide certification. The finding is: [...]

Inspectors wroteBased on observation, interview, and record review conducted during a Complaint investigation (NY00344362 and NY00345636) conducted during a Standard survey completed on 7/15/24, the facility did not ensure that housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior for three (Second, Third, and Fourth Floors) of three resident units and one of one main dining room. Specifically, multiple windows had dried leaves, dead insects, spider webs white and grey colored debris on the inside and outside on windowpanes and brown/black debris on the window sash in between the panes of glass; privacy curtains with reddish brown stains; tan stains and cracks on the ceilings; water dripping from the ceiling into a resident's room on the Third Floor; bathroom lights were dim and not in proper working order; resident room walls were in disrepair; [...]

Inspectors wroteBased on interview and record review conducted during the Standard survey completed on 7/15/24, the facility did not ensure that services provided by the facility as outlined in the comprehensive care plan, met professional standards of quality for one of (Resident #23) of six residents reviewed. Specifically, medications were known to be transcribed erroneously which resulted in duplicate orders. The medication orders were not clarified or reported to a medical provider. In addition, the nursing staff signed both of the medications as being administered on multiple occasions. The finding is: The policy and procedure titled Medication and Treatment Orders with revised date July 2016, documented that orders for medications and treatments would be consistent with principles of safe and effective order writing. [...]

Inspectors wroteBased on observation, interview, and record review conducted during a Standard survey completed on 7/15/24, the facility did not store, prepare, distribute, and serve food in accordance with professional standards for food service safety. Specifically, two (Unit 2 and Unit 4) of three unit nourishment refrigerators, one of one main kitchen observed had issues. The nourishment room refrigerators contained undated, unlabeled, and out of date food and drink items. The kitchen walk-in, beverage reach-in and tray line coolers contained undated and unlabeled items. The beverage reach-in cooler contained potentially hazardous beverages that exceeded the safe holding temperature for cold beverages.

Inspectors wroteBased on interview and record review conducted during a Standard Survey completed on 7/15/24, the facility did not ensure that all alleged violations including abuse, neglect, exploitation, or mistreatment were reported immediately, but not later than two hours after the allegation was made to the facility's Administrator for two (Resident #26 and Resident #107) of nine residents reviewed. Specifically, Resident #26 was found to have an injury of unknown origin and Resident #107 had a resident to staff altercation which were not reported to the administrator immediately.

Inspectors wroteBased on observation, interview, and record review conducted during a Standard survey completed on 7/15/24, the facility did not ensure that a resident who was unable to carry out activities of daily living received the necessary services to maintain good grooming and personal hygiene for one (Resident #9) of six residents reviewed. Specifically, Resident #9 who was dependent on staff for hygiene was not assisted with removing unwanted facial hair. The finding is: The policy and procedure titled Activities of Daily Living (ADL) dated March 2018 documented appropriate care and services will be provided for residents who are unable to carry out activities of daily living independently, with the consent of the resident and in accordance with the plan of care. [...]

Inspectors wroteBased on observation, interview, and record review conducted during the Standard survey completed on 7/15/24, the facility did not ensure residents with pressure ulcers received necessary treatment and services, consistent with professional standards of practice, to promote healing, and prevent new ulcers from developing for one (Resident #68) of two residents reviewed. Specifically, Resident #68 was not provided with an air mattress (a mattress that provides air flow to relieve pressure) as ordered by the physician. Additionally, nursing staff were inaccurately documenting that the air mattress was provided. The finding is: [...]

Inspectors wroteBased on observation, interview, and record review conducted during a Standard survey completed on 7/15/24, the facility did not ensure that residents who receive a psychotropic medication have gradual dose reductions, unless clinically contraindicated, in an effort to discontinue these drugs for one (Resident #63) of five residents reviewed for psychotropic medication use. Specifically, Resident #63 had no attempted gradual dose reductions since Prozac (antidepressant medication) was ordered on 3/3/23 and there was a lack of adequate supporting evidence for its continued use. The finding is: [...]

Inspectors wroteBased on observation, interview, and record review conducted during a Complaint Investigation (#NY00329637) completed on 2/22/24, the facility did not provide pharmaceutical services including procedures that assure the accurate acquiring, receiving, dispensing, and administration of all drugs and biologicals to meet the needs of each resident for three (Resident #1, 2 and 3) of nine residents reviewed. Specifically, the facility did not obtain regularly scheduled medications from the pharmacy for Residents #1, 2 and 3 as ordered by the physician which resulted in multiple missed doses.

Inspectors wroteBased on interview and record review conducted during a Complaint Investigation (#NY00329506) completed 12/21/23, the facility did not ensure that all alleged violations of abuse, were reported immediately, but not later than two hours after the allegation was made, to the administrator and other officials including the State Survey Agency for one (Resident #1) of three resident reviewed. Specifically, alleged resident to resident abuse was not reported, in the appropriate timeframe, to the New York State Department of Health. The finding is: The policy and procedure titled Abuse, Neglect, Exploitation or Misappropriation - Reporting and Investigating revised in April 2021, documented that if alleged abuse is suspected, it must be reported immediately to the administrator and to other officials according to state law. [...]

Inspectors wroteBased on interview and record review conducted during a complaint investigation (#NY00329506) completed 12/21/23, the facility did not ensure that all alleged of abuse, were thoroughly investigated for one (Resident #1) of three residents reviewed. Specifically, the facility did not complete a thorough investigation into an allegation of resident to resident abuse to include interviews with Resident #1 and staff. The finding is: The policy and procedure titled Abuse, Neglect, Exploitation or Misappropriation - Reporting and Investigating revised in April 2021, documented that all allegations of abuse are to be thoroughly investigated. At a minimum, the investigation should include: [...]

Inspectors wroteBased on observation, interview, and record review conducted during the Standard survey started on 6/9/22 and completed on 6/16/22, the facility did not ensure that the residents' environment remains as free from accident hazards as is possible. Specifically, three (Units 2, 3, and 4) of three resident care units had issues with water temperatures exceeding 120 degrees Fahrenheit (°F) in resident rooms and care areas.

Inspectors wroteBased on observation, interview, and record review during a Complaint Investigation (Complaint #NY00257807) completed during a Standard survey started [DATE] and completed [DATE], the facility did not ensure that residents who require dialysis, received services consistent with professional standards of practice for two (Resident #51 and 280) of three residents reviewed for dialysis. Specifically, the issues involved the lack of physician orders for dialysis (#51, #280); the lack of transporting a resident to hemodialysis (HD) causing resident to miss scheduled dialysis appointments ([DATE], [DATE], [DATE], and [DATE]) and the physician was not notified (5/23-[DATE]) of missed dialysis treatments (#280); lack of monitoring the vascular access site (a tube or device surgically implanted to create an artificial connection between an artery and a vein- used for HD) (#280). [...]

Inspectors wroteBased on observation, interview, and record review during the Standard survey completed 6/9/22 through 6/16/22, the facility did not maintain the resident call bell system in working order. Specifically, call bells in resident rooms and resident bathrooms did not activate the calls light above the residents' room doors and did not activate the central station at the Nurses' Station. This affected one (Third Floor) of three resident units.

Inspectors wroteBased on observation, interview and record review conducted during the Standard survey started 6/9/22 and completed 6/16/22, the facility did not ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for one (Resident #117) of one resident reviewed for quality of care related to skin conditions. Specifically, the facility did not address suture removal timely, and there was a lack documented evidence in the medical record regarding the suture removal. The finding is: Review of the facility policy and procedure titled admission Criteria dated 12/2016 revealed residents will be admitted to this facility as long as their nursing and medical needs can be met adequately by the facility. [...]

Inspectors wroteBased on observation, interview and record review conducted during the Standard survey started 6/9/22 and completed 6/16/22, the facility did not ensure that each resident's drug regime is free from unnecessary drugs. An unnecessary drug is any drug when used in excessive dose or duration, without adequate monitoring, without adequate indication, in the presence of adverse consequences and in any combination of reasons as stated. Specifically, two (Resident #230 and #82) of five residents reviewed for unnecessary medications had issues. Resident #230 received Flagyl (antibiotic medication) for an excessive duration without adequate indications for its continued use and Resident #82 did not have adequate monitoring of blood sugars as ordered by physicians.

Inspectors wroteBased on observation, interview, and record review conducted during an Complaint Investigation (Complaint NY00252067) during the Standard survey completed on 2/28/20, it was determined that the facility did not provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior. Specifically, three (Units 2, 3, 4) of three resident units observed for sanitary and comfortable environment had issues involving damaged and soiled walls, damaged ceilings, soiled floors, a missing shower curtain, a soiled chair, soiled privacy curtains, dust-laden surfaces, damaged window sills, soiled and ripped floor mats and pads, a toilet tank missing its cover, wall-mounted night lights missing covers, improper garbage storage, and foul odors.

Inspectors wroteBased on observation, interview, and record review conducted during the Standard survey completed on 2/28/20, the facility did not treat each resident with respect and dignity and care for each resident in a manner and in an environment, that promotes maintenance or enhancement of his or her quality of life for one (Residents #39) of two residents reviewed for dignity. Specifically, Resident #39's breakfast tray was served/ placed on soiled bed linens while the resident sat naked from the waist down in a stationary chair. There was no over the bed table and there was a soiled incontinence brief on the floor next to the resident. The finding is: The facility policy titled Quality of Life-Dignity dated 2009 revealed each resident shall be cared for in a manner that promotes and enhances quality of life, dignity, respect, and individuality. [...]

Inspectors wroteBased on interview and record review conducted during a complaint investigation (Complaint #NY00249229) during the Standard survey completed on 2/28/20, the facility did not ensure the resident's right to choose activities, schedules, and health care consistent with his or her interests, assessments, and plans of care; and make choices about aspects of his or her life in the facility that are significant to the resident. Specifically, one (Resident #44) of four residents reviewed for choices had an issue involving showers that were not provided in accordance with a resident's wishes. The finding is: 1. Resident #44 had diagnoses including Parkinson's disease, major depressive disorder, and muscle weakness. The Minimum Data Set (MDS - a resident assessment tool) dated 12/7/19 documented the resident was cognitively intact and needed physical help in part of bathing activity. [...]

Inspectors wroteBased on observation, interview and record review conducted during the Standard survey completed on 2/28/20, the facility did not develop and implement an effective discharge planning process that focuses on the resident's discharge goals, the preparation of residents to be active partners and effectively transition them to post-discharge care for two (Residents #120, 123) of four residents reviewed for discharge planning. Specifically, the facility did not implement a discharge plan for Resident #120 who completed subacute rehab (SAR) and wished for a lateral transfer to another SNF and for Resident #123 who expressed wishes to return to the community.

Inspectors wroteBased on observation, interview, and record review conducted during a Standard survey completed on 2/28/20, it was determined that the facility did not ensure that a resident who was unable to carry out activities of daily living receives the necessary services to maintain good grooming, and personal hygiene. Specifically, one (Resident #21) of three residents reviewed for activities of daily living (ADLs) had issues with poor oral hygeine observed on multiple days and the CNA (Certified Nurse Aide) did not provide oral care during morning care. The finding is: 1. Resident #21 had diagnoses including cerebral infarction (stroke), dysphagia (difficulty swallowing), and traumatic brain injury (TBI). The Minimum Data Set (MDS - a resident assessment tool) dated 2/19/20 documented the resident had severe cognitive impairment and required extensive assistance with hygiene. [...]