North Country Nursing & Rehabilitation Center

Inspectors wroteBased on record review, observations, and interview during the recertification and abbreviated surveys (NY00351103) conducted 8/11/2025-8/15/2025, the facility did not ensure facility menus reflected input received from residents and resident groups for 7 of 7 anonymous residents present at the resident group meeting. Specifically, generic menus were provided to the residents without specific fruits and vegetables to be served and had repetitive starches daily resulting in complaints about the lack of variety in food options.

Inspectors wroteBased on observations, record review, and interviews during the recertification survey conducted 8/11/2025-8/15/2025, the facility did not store, prepare, distribute and serve food in accordance with professional standards for food service safety for one (1) of one (1) main kitchen reviewed. Specifically, the main kitchen dish machine did not reach the temperature required to sanitize soiled dishware; food in the freezer was not labeled or dated; the dish machine temperature log and three bay sink sanitizer testing logs were not completed every day; and appropriate hand hygiene was not performed.

Inspectors wroteBased on observations, record review, and interviews during the recertification survey conducted 8/11/2025-8/15/2025, the facility did not ensure residents maintained acceptable parameters of nutritional status for one (1) of one (1) resident (Resident #11) reviewed. Specifically, Resident #11 had unplanned significant weight loss; nutritional interventions were not included in the care plan or implemented timely; staff assistance was not provided at meals; and there was no documented evidence the medical provider was notified of the weight loss.

Inspectors wroteBased on observations, record review, and interviews during the recertification survey conducted 8/11/2025-8/15/2025, the facility did not ensure garbage and refuse was disposed of properly. Specifically, facility garbage areas were not maintained to prevent attraction and harborage of pests.

Inspectors wroteBased on observations and interviews during the recertification survey conducted 8/11/2025- 8/15/2025, the facility did not ensure a safe, functional, sanitary, and comfortable environment for residents, staff, and the public in one (1) of (3) three units (Unit 200). Specifically, Unit 200 hallway was unclean and had odors.

Inspectors wroteBased on record review and interview conducted during the recertification survey on 12/11/2023 - 12/15/2023, the facility did not ensure sufficient staff with the appropriate competencies and skills to carry out the function of the food and nutrition service were in place at the facility. Specifically, the facility did not have a qualified person to serve as the Director of Food and Nutrition services or a qualified dietician onsite at the facility to carry out food and nutrition services.

Inspectors wroteBased on observation, record review and interview during the recertification survey and abbreviated survey (NY00299190) 12/11/2023 - 12/15/2023, the facility did not ensure the main kitchen was maintained in accordance with professional standards for food service safety in the main kitchen. Specifically, the floors, ice machine and walk-in freezer were unclean with food debris and ice buildup. In addition, there was no hand wash sign adjacent to the dish machine and cartons of milk were stored past expiration date in the milk cooler.

Inspectors wroteBased on observation, record review and interviews during the recertification survey conducted 12/11/2023 -12/15/2023, the facility did not establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment, to help prevent the development and transmission of communicable diseases and infections for 10 of 10 staff members (certified nurse aides #1, 2, 6,10, 11,17 and 21 and licensed practical nurse unit managers #3, 9 and13) observed entering droplet precaution or COVID-19 resident rooms for 7 of 7 residents (Residents #27, 72, 31, 120, 121 and 382), 2 of 2 residents (#101 and 121) who were COVID-19 positive observed in common areas with non-positive residents and for 1 of 1 (Resident #63) residents with a urinary catheter reviewed. Specifically: [...]

Inspectors wroteBased on record review and interview during the recertification survey conducted 12/11/2023 -12/15/2023, the facility did not ensure a comprehensive person-centered care plan was developed and implemented for each resident that included measurable objectives and timeframes to meet a resident's medical and nursing needs for 1 of 2 residents (Resident #22) reviewed. Specifically, Resident #22's wheelchair seat belt was not removed at meals as planned.

Inspectors wroteBased on observation, record review, and interview during the recertification and abbreviated (NY00293414, NY00294008, NY00299190, NY00300100, and NY00308466) surveys conducted 12/11/2023 - 12/15/2023, the facility did not ensure residents who were unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for 2 of 12 residents (Residents #27 and #124) reviewed. Specifically, Resident #27 and #124, were not provided with adaptive equipment during meals as ordered for multiple days of survey.

Inspectors wroteBased on observation, record review and interview during the recertification survey conducted 12/11/2023 - 12/15/2023, the facility did not ensure a resident with limited range of motion received appropriate treatment and services to increase range of motion and/or prevent further decrease in range of motion and proper positioning for 2 of 6 residents (Residents #36 and #38 ) reviewed. Specifically, Resident #36 did not have a left hand splint as ordered and planned; Resident #38 did not have supportive devices for their wheelchair or frequent positioning as planned.

Inspectors wroteBased on observation, record review, and interview during the recertification survey conducted 12/11/2023 - 12/15/2023, the facility did not ensure residents who needed respiratory care were provided such care, consistent with professional standards of practice for 1 of 1 residents (Resident #124) reviewed. Specifically, Resident #124 received oxygen at a flow rate that was not consistent with physician orders.

Inspectors wroteBased on record review and interview during the recertification survey conducted 12/11/2023 - 12/15/2023, the facility did not ensure that a resident who required dialysis received such services consistent with professional standards of practice for 1 of 1 residents (Resident #34) reviewed. Specifically, Resident #34 did not receive a complete post-dialysis treatment assessment of their fistula (direct connection between an artery and a vein; dialyis access site) by a registered nurse.

Inspectors wroteBased on observation, interview, and record review during the recertification survey and abbreviated survey (NY00299190) 12/11/2023 - 12/15/2023, the facility did not ensure food was served at palatable and appetizing temperatures in accordance with professional standards for food service safety in the main kitchen. Specifically, 4-ounce cartons of milk on the tray line (approximately 50) as well as on 1 of 2 test trays measured 63-64 degrees Fahrenheit on one day of survey. In addition, one lunch meal was burned and appeared over cooked at the steam table in the main kitchen, and, 1 of 2 test trays tasted over-cooked.

Inspectors wroteBased on observation, record review and interview during the recertification survey conducted from 6/29-7/2/21, the facility did not ensure each resident had a right to a dignified existence for 2 of 9 residents (Residents #71 and 72) reviewed and for 1 of 2 units (Unit 200) reviewed. Specifically, Residents #71 and 72 were not served their meals and other residents were served and eating before them, and residents on Unit 200 were referred to in a manner that was not dignified.

Inspectors wroteBased on observation, record review and interview during the recertification and abbreviated (NY00274642 and NY00277985) surveys conducted from 6/29/21-7/2/21, the facility did not ensure that residents who are unable to carry out activities of daily living (ADLs) receive the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for 5 of 12 residents (Residents #2, 18, 22, 36 and 54) reviewed. Specifically, Resident #18 was not assisted with showers as scheduled. Resident #22 was not provided facial hair grooming or nail care. Resident #54 was not toileted timely. Residents #2 and #36 were not dressed or assisted out of bed per their preference.

Inspectors wroteBased on observation, interview and record review during the recertification and abbreviated surveys (NY00274642, NY00275020, and NY00277985) conducted 6/29/21 through 7/2/21, the facility failed to ensure sufficient nursing staff to provide nursing services to attain or maintain the highest practicable physical, mental, and psychsocial well-being for all 108 residents in the facility. Specifically, the facility did not ensure there was sufficient staff to meet resident needs in the areas of activities of daily living, medication administration, resident rights, and nutrition/hydration status. In addition, during the resident group meeting multiple anonymous residents stated meals were late and cold, medications were given late, showers were not given, call lights were not answered timely and beds were not changed or made.

Inspectors wroteBased on observation and interview during the recertification survey conducted from 6/29/21-7/2/21, the facility did not ensure food and drink was palatable, attractive, and at safe and appetizing temperatures for 2 of 2 meals reviewed. Specifically, food was not served at palatable temperatures for 2 lunch meals.

Inspectors wroteBased on observation and interview during the recertification survey conducted from 6/29-7/2/21, the facility did not ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences for 9 residents (Residents #4, 18, 31, 33, 39, 50, 54, 82, and 96) and 3 anonymous residents. Specifically, Residents #4, 18, 31, 33, 39, 50, 54, 82, 96 and 3 anonymous residents at the resident group meeting did not receive food items as specified on their meal tickets.

Inspectors wroteBased on observation, interview, and record review during the recertification survey conducted from 6/29/21-7/2/21, the facility did not establish and maintain an infection prevention and control program to ensure the health and safety of residents and to prevent the transmission of COVID-19 and communicable diseases and infections for 1 of 3 residents (Resident #252) reviewed for transmission based precautions, 1 of 1 licensed practical nurse (LPN #11) reviewed for tube feeding administration, and 1 of 4 nurses (LPN #18) reviewed for medication administration. Specifically, the facility did not ensure proper hand hygiene and infection control practices (LPNs #11 and 18) and proper personal protective equipment (PPE, Resident #252) were used.

Inspectors wroteBased on interview and record review during the recertification survey conducted on 6/29/21-7/2/21, the facility did not ensure each resident received adequate supervision and assistance devices to prevent accidents for 1 of 3 (Resident #101) residents reviewed. Specifically, Resident #101 sustained multiple falls out of bed and their care plan was not updated with interventions to prevent further falls.

Inspectors wroteBased on observation, record review and interview during the recertification and abbreviated (NY00277042 and NY00275020) surveys conducted from 6/29-7/2/21, the facility did not maintain acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance for 2 of 9 residents (Residents #22 and 99) reviewed. Specifically, Resident #22 was not weighed monthly as ordered and when they were weighed there was a significant weight loss and a re-weight was not completed. Resident #99 had a significant loss and staff did not re-weigh the resident to ensure proper nutritional interventions were in place.

Inspectors wroteBased on observation, record review and interview during the recertification survey conducted from 6/29-7/2/21, the facility did not ensure that a resident who needs respiratory care, is provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 1 of 1 resident (Resident #50) reviewed. Specifically, Resident #50 had orders for both continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) therapy (both use compressed air to open airway). There were no treatment administration directions for these devices, no orders in place for the care of the equipment, and the care plan was not updated to include these interventions.

Inspectors wroteBased on observation, interview, and record review during the recertification survey conducted from 6/29/21-7/2/21, the facility failed to ensure medication rates were not greater than 5 percent for 2 of 9 residents (Resident #20 and 72) reviewed. Specifically, Resident #72 was provided an alternative type of insulin without a physician order and Resident #20 was administered three medications over one hour late. The facility's medication error rate was 7.55%. This is evidenced by: The undated facility policy Medication Administration documents the nurse is responsible for checking to see if the medication and dosage schedule on the resident's Medication Administration Record (MAR) matches the label on the medication's container. [...]

Inspectors wroteBased on observation, record review and interview during the recertification survey conducted from [DATE]-[DATE], the facility did not ensure drugs and biologicals used in the facility were labeled in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable for 1 of 2 medication rooms (Unit 2) and 1 of 3 medications carts (Unit 2 medication cart L) reviewed. Specifically, expired stock medications were observed in the medication room and on medication cart L. This is evidenced by: The facility policy Storage of Medications revised 4/2007 documented nursing staff shall be responsible for maintaining medication storage. The facility shall not use discontinued, outdated, or deteriorated drugs or biologicals, all such drugs should be returned to the pharmacy or destroyed. [...]

Inspectors wroteBased on observation, record review and interview during the recertification survey conducted from 6/29-7/2/21, the facility did not ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs for 2 of 4 residents (Resident #20 and 61) reviewed. Specifically, Resident #61 was recommended for a pureed diet and received a soft cookie on two occurrences. Resident #20 was recommended for a pureed diet and received a pudding pie with graham cracker crust. This is evidenced by: The undated Diet Manual documents a pureed diet limits meal items to smooth or semi-smooth food textures. Bread is not included on this diet unless approved by the Speech Pathologist or physician. Foods to avoid includes desserts that were not mechanically altered; pudding was allowed on a pureed diet. [...]