Park Avenue Extended Care Facility

Inspectors wroteBased on observations, record review, and interviews during the Recertification and Abbreviated Survey (NY 00331717) initiated on 10/28/2024 and completed on 11/4/2024, the facility did not ensure it had sufficient nursing staff on a 24-hour basis to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. This was identified on six of six resident units during the Sufficient Staffing Task. Specifically, 1) the Facility Assessment did not match the number actual number of Certified Nursing Assistants assigned to work on each unit; 2) medications during the 7:00 AM-3:00 PM shift were administered late on the 3rd and 5th floor nursing units due to understaffing issue; [...]

Inspectors wroteBased on observation, interviews, and record review conducted during the Recertification Survey, initiated on 10/28/2024 and completed on 11/4/2024, the facility did not ensure that food was stored, prepared, distributed, and served in accordance with professional standards for food service safety. This was evident during the Kitchen task observation. Specifically, frozen food items (pancakes, sausage patties, beef burger patties) were stored undated and with opened packaging. The finding is: The facility's policy titled Food Receiving and Storage, dated 12/2023, documented that Supervisors will observe all refrigerated and frozen goods for the integrity of the wrapping materials as a primary barrier to cross-contamination. The management team will ensure that all products are labeled and dated by the staff and utilized by their expiration date. [...]

Inspectors wroteBased on observations, record review, and interviews during the Recertification Survey initiated on 10/28/2024 and completed on 11/4/2024 the facility did not ensure call systems were accessible to each resident while the residents were in their rooms. This was identified for three (Resident #350, Resident #4, and Resident #87) of three residents reviewed for call systems. Specifically, 1) Resident #350, who was assessed to require assistance with transfer and locomotion, was observed in their room alone sitting in a chair; the call bell was observed on the floor approximately five feet away from the resident; 2) Resident #4, who was assessed to require staff assistance with transfers and locomotion, was observed on 10/28/2024 and 10/29/2024; the call bell was observed out of the resident's reach; [...]

Inspectors wroteBased on observations, record review, and interviews during the Recertification Survey initiated on 10/28/2024 and completed on 11/4/2024 the facility did not ensure that each resident was treated with respect and dignity and cared for in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life. This was identified for two (Resident #92 and Resident #87) of four residents reviewed for Dignity. Specifically, on 10/28/2024, Resident #92 and Resident #87, who resided in the same room, were observed in bed with multiple layers of linen, cloth chucks (pads used to protect the bed linen), and plastic liners. Additionally, both residents were wearing multiple briefs that were saturated with urine and the room had a strong urine odor.

Inspectors wroteBased on interviews and record review during the Recertification Survey and Abbreviated Survey (NY 00332218) initiated on 10/28/2024 and completed on 11/4/2024, the facility did not ensure that services provided or arranged by the facility meet the current professional standards of quality This was identified for one (Resident #14) of two residents reviewed for Choices. Specifically, on 1/16/2024 the Physician ordered Diclofenac 0.1% (nonsteroidal anti-inflammatory) eye drops for 14 days Resident #14. The Diclofenac eye drops were not delivered by the pharmacy and were not available for administration until 1/24/2024; however, the nursing staff documented that the eye drops were administered to Resident #14 on 11 occasions between 1/16/2024 and 1/23/2024. The finding is: [...]

Inspectors wroteBased on observation, record review, and staff interview during the Recertification Survey initiated on 10/28/2024 and completed on 11/4/2024 the facility did not ensure that residents who are unable to carry out activities of daily living receive the necessary services to maintain good grooming and personal hygiene. This was identified for two (Resident #92 and Resident #87) of three residents reviewed for activities of daily living. Specifically, 1) Resident #92 required staff assistance with activities of daily living care. During an observation on 10/28/2024, the resident did not receive their morning care until 12:50 PM. The resident stated they were wet and had not received care since the 11:00 PM-7:00 AM shift. 2) Resident #87 required staff assistance for the activity of daily living care. [...]

Inspectors wroteBased on record review and interviews during the Recertification Survey and Extended Survey (NY 00331717), initiated on 10/28/2024 and completed on 11/4/2024, the facility did not ensure each resident with pressure ulcers received necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection, and prevent new ulcers from developing. This was identified for two (Resident #156 and Resident #48) of four residents reviewed for Pressure Ulcers. Specifically, 1) Resident #156 entered the facility on 7/10/2024 with unstageable (the depth and stage of the wound cannot be determined until dead tissue is cleared away or removed and the base of the pressure injury is visible) pressure ulcers to their right and left heels; however, there was no documented evidence of treatment administration to the wound sites until 7/23/2024; [...]

Inspectors wroteBased on observations, record review, and interviews during the Recertification Survey initiated on 10/28/2024 and completed on 11/4/2024, the facility did not ensure that each resident maintained, to the extent possible, acceptable parameters of nutritional, and hydration status. This was identified for one (Resident #102) of one resident reviewed Dialysis. Specifically, Resident #102 had a physician's order for fluid restriction of 1200 milliliters per day. Resident #102's meal tickets and Electronic Medication Administration Record (EMAR) indicated the resident was receiving fluids that were exceeding the physician-ordered daily amount. The finding is: The facility's policy titled, Fluid Restrictions dated 3/2024, documented the facility provides fluid restrictions for residents placed on such restrictions per the discretion of the Physician. [...]

Inspectors wroteBased on record review and interviews conducted during a Recertification Survey initiated on 10/28/2024 and completed on 11/4/2024, the facility did not ensure the Physician provided orders for the resident's immediate care and needs. This was identified for one (Resident #75) of two residents reviewed for Choices. Specifically, Resident #75 with a diagnosis of Epilepsy was receiving Topiramate (anticonvulsant medication) that should be gradually withdrawn to minimize the potential for seizures or increased seizure frequency as per the manufacturer's warning and precautions. The medication was abruptly stopped from 10/19/2024 to 10/22/2024 and restarted after four days on 10/23/2024. The finding is: [...]

Inspectors wroteBased on observation and interviews during the Recertification Survey initiated on 10/28/2024 and completed on 11/4/2024 the facility did not ensure that daily nursing staffing was posted in a prominent location and with the numbers of Registered Nurses, Licensed Practical Nurses, and Certified Nurse Aides who were working that day. Specifically, the facility lobby, near the front entrance, near the elevator bank, and the elevators were observed on 10/28/2024 at 8:55 AM and then again at 10:05 AM. There was no daily staffing posted that included the total number of licensed and unlicensed nursing staff working per shift. The finding is: During an observation on 10/28/2024 at 8:55 AM and again on 10/28/2024 at 10:05 AM, nursing staff posting was absent in the facility lobby and near the front entrance, near the elevator bank, in the elevators, and on the unit on the 8th floor. [...]

Inspectors wroteBased on interviews and record review during the Recertification Survey and Abbreviated Survey (NY 00332218) initiated on 10/28/2024 and completed on 11/4/2024, the facility did not ensure that pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drug and biologicals) were provided to meet the needs of each resident. This was identified for one (Resident #14) of two residents reviewed for Choices. Specifically, Resident #14's Physician ordered Diclofenac 0.1% (nonsteroidal anti-inflammatory) eye drops for 14 days on 1/16/2024. The eye drop medication was not delivered to the facility by the Pharmacy until 1/24/2024. The finding is: [...]

Inspectors wroteBased on record review and interviews during the Recertification Survey initiated on 1/19/2023 and completed on 1/26/2023, the facility did not ensure that residents who requested the Pneumococcal Vaccination received the Pneumococcal Vaccinations in a timely manner. This was identified for three (Resident #17, and #23, #60) of five residents reviewed for immunization. Specifically, Resident #17, #23, and #60 signed a consent form to receive the Pneumococcal Vaccine in September 2022, however, all three residents did not receive the vaccine as per their request. The finding is: The Facility's Policy and Procedure for Influenza & Pneumococcal Immunization dated 4/2022 documented that the Pneumococcal vaccine will be offered upon admission. Residents are given the right to accept or refuse the vaccination, given the resident is provided proper education for declination. [...]

Inspectors wroteBased on observation, record review, and interviews during the Recertification Survey initiated on 1/19/2023 and completed on 1/26/2023 the facility did not ensure that services are provided for each resident to restore or improve normal bladder function to the extent possible, after the removal of the indwelling catheter. This was identified for one (Resident #115) of three residents reviewed for Urinary Catheter. Specifically, Resident #115 had a Foley catheter and was started on a trial void (a trial of void assesses the ability of the bladder to empty without the use of a urinary catheter) per Physician's order on 11/25/2022. There was no documented evidence that the resident was monitored for voiding after the Foley catheter was discontinued. On 11/26/2022 the resident was identified by Registered Nurse (RN) #4 with abdominal distension and discomfort. [...]

Inspectors wroteBased on record review and staff interviews during the Recertification Survey initiated on 1/19/2023 and completed on 1/26/2023 the facility did not ensure that each resident's medical care was supervised by a physician throughout the resident's stay for 1 (Resident #367) of 1 resident reviewed for Dialysis. Specifically, Resident #367, who had a diagnosis of Orthostatic Hypotension (low blood pressure that happens when standing after sitting or lying down position), had an order for Midodrine (a medication used to treat low blood pressure). There was a Physician's order to monitor the blood pressure; however, the order did not provide guidance regarding blood pressure parameters to hold Midodrine medication and when to contact the Physician. [...]

Inspectors wroteBased on staff interviews and record review during the Recertification survey the facility did not ensure that each resident had a person-centered Comprehensive Care Plan (CCP) developed and implemented to meet the resident's medical, nursing, psychosocial needs. This was identified for 1 (Resident #209) of 4 residents reviewed for Pressure Ulcer; 1 (Resident #58) of 3 residents reviewed for nutrition; and 1 (Resident # 103) of 4 residents reviewed for Mood and Behavior. [...]

Inspectors wroteBased on observation, record review and interview during the Recertification Survey the facility did not ensure that each residents Comprehensive care Plan (CCP) was reviewed and revised to reflect the resident's most current status. This was identified for 1 (Resident #209) of 4 residents reviewed for Pressure Ulcers. Specifically, Resident # 209 did not have the Pressure Ulcer CCP updated to reflect the intervention of using heel booties. The finding is: The facility Comprehensive Care Plan dated 3/2019 documented that the comprehensive care plan shall be reviewed and updated by the interdisciplinary team if the resident's condition warrants it. Each discipline is responsible for assessing the resident and completing their required documentation in the medical record. [...]

Inspectors wroteBased on observation, record review and interviews during the Recertification Survey, the facility did not provide timely services to prevent the development of a Stage 3 Sacral Pressure Ulcer. This was identified for one (Resident #198) of four residents reviewed for Pressure Ulcers (PU). Specifically, Resident # 198 with moderate risk for developing PU was identified with a skin opening to the left buttock by the Certified Nursing Assistants (CNAs) on 1/20/2020, 1/21/2020 and 1/25/2020. The CNAs reported skin impairment to a Licensed Practical Nurse (LPN). The resident's medical records lacked documented evidence of an assessment by a qualified health professional or a physician's order for a treatment to the left buttock until after 15 days on 2/4/2020 when the left buttock wound was identified as a Stage 3 Pressure Ulcer. [...]

Inspectors wroteBased on observation, record review and interviews during the recertification survey, the facility did not ensure that residents were free from significant medication errors. This was identified for one of four residents reviewed for Choices. Specifically, for Resident #162, the facility did not ensure the resident was administered Metoprolol in accordance with the physician's order for 4 days in January 2020 and 15 days in February 2020. The finding is: The policy and procedure for Medication Administration, dated 1/1/20 documented the licensed nurse will assure the 5 rights as follows; compares the medication name, strength, route and dosage schedule on the medication administration record against the prescription label. Always checks three times prior to the administration of the medication. [...]

Inspectors wroteBased on record review and staff interviews during the Recertification Survey, the facility did not assure that each resident receives an accurate assessment, reflective of the resident's status at the time of the assessment. This was identified for one (Resident #211) of three residents reviewed for Nutrition. Specifically, Resident #211's Quarterly Minimum Data Set (MDS) assessment did not include the resident's weight. The finding is: Resident #211 was admitted with diagnoses including Diabetes Mellitus, Morbid Obesity, and Stage 5 Chronic Kidney Disease. The resident was receiving Hemodialysis (HD) three times a week. A Quarterly Minimum Data Set (MDS) assessment dated [DATE] had no documented weights in section K. A Comprehensive Care Plan (CCP) for Nutrition, initiated on 12/6/16 and updated through 2/12/20, documented the resident continued to refuse to be weighed in the facility; [...]