Orchard Rehabilitation & Nursing Center

Inspectors wroteBased on interview and record review conducted during a Complaint investigation (NY00358687-745392) completed on 09/02/2025, the facility did not ensure sufficient nursing staff to attain or maintain the highest practicable physical, mental, and psychosocial wellbeing of each resident. Specifically, the facility did not ensure there was sufficient nurse staffing to meet the needs of the residents in accordance with their preferences and plans of care. The finding is:Review of the Dear Administrator letter 23-11 dated 06/30/23 sent to the nursing home administrators informing them that starting 04/01/2022 nursing homes were required to have an average daily staffing of 3.5 hours of care per resident per day with 2.2 hours for Certified Nurse Aides and 1.1 hours for Licensed Practical Nurses or Registered Nurses. [...]

Inspectors wroteBased on observation, interview, and record review conducted during a Complaint investigation (NY00358687- 745392) the facility did not ensure food and drink were provided/served at a safe and appetizing temperatures. Specifically, food and beverages during the lunch meal were served at suboptimal temperatures and were not palatable. Residents #1, #4, #5, #6, and #7 involved. The finding is: The policy Safe Food Temperature and Danger Zone Compliance dated 04/2025 documented the facility will maintain strict control of food temperatures to prevent the growth of harmful bacteria. [...]

Inspectors wroteBased on observation, interview, and record review conducted during the Standard survey completed on 4/16/24, the facility did not provide food and drink that was at a safe and appetizing temperature for four (Main Dining Room, Unit 1, Unit 2, and Unit 3) of four test trays. Specifically, food and beverages during meals were served at suboptimal temperatures. Residents #85, #74, #51, #4, and #1, were involved.

Inspectors wroteBased on observation, interview, and record review conducted during a Standard survey completed on 4/16/24, the facility did not store, prepare, distribute, and serve food in accordance with professional standards for food service safety. Specifically, three (Unit 1, Unit 2, and Unit 3) of three-unit nourishment refrigerators, one of one main kitchen, and one (Main dining room and Unit 3 Dining Room) of two serveries observed had issues. The nourishment room refrigerators contained undated, unlabeled, and out of date food and drink items. The kitchen had a greasy oven door, the splatter guard behind the stove was heavily soiled with dried brown/black grease; a commercial coffee maker and its carafes were heavily soiled with coffee stains, and there was a rusty and dusty desk fan under the tray line. [...]

Inspectors wroteBased on observation, interview, and record review conducted during a Standard survey completed on 4/16/2024, the facility did not ensure that the residents' environment remained as free from accident hazards as possible, and each resident receives adequate supervision for one (Resident #116) of one resident reviewed. Specifically, the facility did not implement their smoking policy to ensure that comprehensive quarterly assessments were completely to ensure safe smoking practices. Additionally, the was no compressive care plan developed for smoking. The finding is: The policy and procedure titled Smoking Policy, dated 10/2017, documented all residents that express a desire to smoke will have a smoking assessment completed to determine their safety and physical ability to smoke. This assessment will be completed on admission, readmission, quarterly and as needed. [...]

Inspectors wroteBased on interview and record review conducted during a Standard survey completed [DATE], the facility did not ensure any individual working in the facility as a nurse aide for more than 4 months was competent to provide nursing and nursing related services for one of five staff (Resident Assistant #1) reviewed for training. Specifically, Resident Assistant #1 functioned in the role of a nurse aide for greater than 4 months without receiving nurse aide certification. The finding is: The Centers for Medicare and Medicaid Services published guidance for expiration of the COVID-19 public health emergency (QSO-23-13-ALL), dated [DATE], documented that previously Centers for Medicare and Medicaid services had waived the requirement that the facility may not employ anyone for longer than four months unless they met training and certification requirements. [...]

Inspectors wroteBased on interview and record review conducted during the Standard survey completed on 4/16/24 the facility did not ensure the Binding Arbitration Agreement provides for the selection of a neutral arbitrator agreed upon by both parties and the agreement provides for the selection of a venue that is convenient to both parties. Specifically, three (Resident #85,137,192) of three residents reviewed there was no documented evidence the arbitration agreement addressed the selection of a neutral arbitrator agreed upon by both parties and the selection of a venue that is convenient to both parties. The finding is: The policy and procedure titled Entering into Binding Arbitration Agreements dated 10/24/22, documented a pre-dispute arbitration agreement is a binding agreement to resolve a future unknown dispute with an arbitrator prior to any issue or dispute arising. [...]

Inspectors wroteBased on observation, interview and record review conducted during a Standard survey completed on 4/25/22, the facility did not develop and implement a comprehensive person- centered care plan for each resident, consistent with the resident rights and that includes measurable objectives and timeframes to meet a resident's medical, nursing and mental and psychosocial needs for three residents (Resident #22, 41 and 53) of 25 residents reviewed. Specifically, there was no comprehensive care plan developed for use of anticoagulant (blood thinner) for Resident #41; the facility did not ensure Resident #22 had their right-hand palm guard (assistive device that positions the fingers away from the palm) in place per the physician's order and Resident #53 was not supervised in common areas per the plan of care.

Inspectors wroteBased on observation, interview, and record review completed during a Standard survey conducted from 4/18/22 through 4/25/22, the facility did not ensure that a resident with pressure ulcers receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection, and prevent new ulcers from developing for one (Resident #41) of one resident reviewed. Specifically, Resident #41's right heel was not floated in bed to off-load pressure from the wound per the Wound Consultant's recommendations.

Inspectors wroteBased on interview and record review conducted during the Standard Survey completed on 6/21/19, the facility did not ensure that the pharmacist reported irregularities to the attending physician and the facility's Medical Director and Director of Nursing (DON). Specifically, one (Resident #137) of five residents reviewed for drug regimen reviews had issues involving the lack of the Consultant Pharmacist's identification and recommendations regarding the continued use of Ativan (antianxiety medication) without an attempt for a gradual dose reduction (GDR). The finding is: The policy and procedure titled Medication Regimen Reviews dated 4/18 documented the consultant pharmacist performs a comprehensive medication regimen review (MRR) at least monthly. [...]

Inspectors wroteBased on observation, interview, and record review conducted during the Standard survey completed on 6/21/19, the facility did not ensure that residents who use psychotropic drugs receive gradual dose reductions (GDR), and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs for one (Resident #137) of five residents reviewed for psychotropic medications. Specifically, Resident #137 lacked GDR attempts for the psychotropic medication Ativan (antianxiety medication), and the lack of documented evidence of behaviors to support the continued use of the medication. The finding is: [...]

Inspectors wroteBased on observation, interview and record review conducted during a Standard survey completed on 6/21/19, the facility did not ensure that drugs and biologicals used in the facility were labeled in accordance with currently accepted professional principals, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable. Specifically, two (Unit 1 Short Hall cart and Unit 2 Long Hall cart) of three medication carts reviewed for the storage of drugs and biologicals had issues with expired medication, and inhalers with no open dates on the package.

Inspectors wroteBased on observation, interview, and record review conducted during the Standard survey completed on 6/21/19, the facility did not provide food for resident consumption that was palatable and at a safe and appetizing temperatures. Three (Main Dining Room, Units 1, 3) of 3 dining areas observed for meal service had issues involving cold food temperatures. Residents #13, 31 and 114 were involved.

Inspectors wroteBased on interview and record review conducted during the Standard Survey completed on 6/21/19, the facility did not ensure that alleged violations including abuse, neglect, exploitation or mistreatment, were thoroughly investigated. One (Resident #34) of five residents reviewed for alleged abuse did not have a completed and thorough investigation conducted for alleged resident to resident abuse. The finding is: Review of a facility policy and procedure titled Accident/Incident - Investigation and Reporting dated 9/2017 revealed upon the observation or report of an accident and or incident which requires an Accident/Incident report form to be completed, the staff member must report the occurrence immediately to the charge nurse and nursing supervisor. This includes, any potential for harm that may occur based on an unsafe condition, item, and/or situation. [...]

Inspectors wroteBased on observation, interview, and record review conducted during the Standard survey completed on 6/21/19, the facility did not ensure that residents who are unable to carry out Activities of Daily Living (ADLs) receive the necessary services to maintain grooming and personal hygiene. Specifically, one (Resident #111) of four residents dependent on staff for ADL's, had long, jagged, dirty fingernails. The finding is: The policy and procedure (P&P) titled Nail Care with a revision date of 2/2018 documented the Registered Nurse (RN) and the Licensed Practical Nurse (LPN) are responsible for nail care on all diabetic residents. Additionally, nail care should be provided on shower/bath day and as needed. 1. Resident #111 was admitted to the facility on [DATE] with diagnoses including schizophrenia, anxiety and diabetes mellitus (DM). [...]

Inspectors wroteBased interview and record review conducted during the Standard survey on 6/21/19, 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 resident's choices for two (Residents #39, 92) of six residents reviewed for quality of care. Specifically, a resident on Hospice services did not have a Hospice care plan in place for facility staff guidance and staff were unsure of what Hospice services the resident received. Additionally, a resident re-admitted to the facility on a diabetic tube feed did not have an order for blood sugar checks (Resident #92).

Inspectors wroteBased on observation, interview, and record review conducted during a Complaint Investigation (Complaint #NY00237037) during the Standard survey completed on [DATE], the facility did not ensure that residents received proper treatment and assistive devices to maintain vision and hearing abilities. The facility must, if necessary assist the resident in making appointments. Specifically, one (Resident #138) of one resident reviewed the facility did not act on the optometry recommendation for a referral for cataract surgery. The finding is: Review of the policy & procedure titled Consults Outside the Facility dated 3/2019 documented the nurse manager will follow up with the physician to discuss any new consult recommendations. This can be done over the phone, in person if the attending is in the facility at the time the resident returns from the consultation. [...]

Inspectors wroteBased on observation, interview and record review conducted during the Standard Survey completed on 6/21/19, the facility did not ensure that each resident who needs respiratory care was provided care consistent with professional standards of practice, the comprehensive person-centered care plan, and the resident's goals and preferences. One (Resident #30) of two residents reviewed for respiratory care had issues. Specifically, the resident was not administered oxygen at the proper liter flow, as ordered by the physician. In addition, certified nurse aides were adjusting liter flow on oxygen concentrators and portable oxygen tanks. [...]