Putnam Ridge

Inspectors wroteBased on observations, interviews, and record review, the facility did not ensure that a resident was free from physical restraints for purposes of discipline or convenience that are not required to treat the resident's medical symptoms and did not ensure the evaluation of the least restrictive alternative for the least amount of time and document ongoing re-evaluation of the need for restraints. This was evident for one resident investigated for Restraints out of three total sampled residents. Specifically, Resident # 1 had a diagnosis of dementia with documented behaviors in nursing progress notes and a history of falls. On 11/27/2025 at approximately 5:55 AM Resident #1 was placed in a wheelchair in the hallway of their unit with a bed sheet wrapped around their waist and the bedsheet was tied securely to the back of the wheelchair.

Inspectors wroteBased on observation, record review and interview conducted during the Recertification and Abbreviated Survey (#2601270, and #2577313), it was determined the facility failed to ensure each resident received adequate supervision and/or assistance to prevent accidents for two (2) of four (4) residents (Resident #164 and #116) reviewed for accidents. Specifically, 1) on the morning of 08/26/2025, Resident #164 was noticed in bed with a contusion (bruise) to their right face, right elbow, and a forehead laceration (skin wound). The facility investigation determined Resident #164 who required two (2) staff assist for bed mobility and/or transfers was provided one (1) staff assist which resulted in an 08/25/2025 fall from bed. [...]

Inspectors wroteBased on record review and interview during the recertification survey and an abbreviated survey (#2601270 and 2577313), the facility did not ensure development and/or implementation of comprehensive person-centered care plans that included measurable objectives and timeframes to meet resident needs for two (2) of four (4) residents (#164 and #116) reviewed for accidents, three (3) of five (5) residents (#20, #44, and #63) reviewed for activities, one (1) of two (2) residents (#41) reviewed for positioning and one (1) of three (3) residents (#142) reviewed for restraints. Specifically, 1. implementation of two person staff assistance for transfer/bed mobility was not provided for Resident #164 as per care plan 2. there was no documented evidence of a care plan to address the use/release schedule of a lap/seat belt for Resident # 142 and 3. [...]

Inspectors wroteBased on observation, interview, and record review during the recertification and abbreviated surveys (#2582376) the facility did not ensure resident choice related to provider of health care services was met for one (1) of one (1) resident investigated for choices. Specifically, Certified Nurse Aide #23 continued to provide care for Resident #75 after their representative communicated a preference of not having Certified Nurse Aide #23 provide care to Resident #75.

Inspectors wroteBased on observation, interview, and record review conducted during the recertification and abbreviated surveys (#2601270), the facility did not ensure all alleged violations of abuse were reported immediately, but not later than 2 hours to the state survey agency for one (1) of two (2) residents reviewed for abuse (Resident #164). Specifically, on the morning of 08/26/2025 Resident #164 was observed with a bruise to the right eye and bruise to the right arm that was not reported to the state agency until 08/26/2025 at 11:05 PM.

Inspectors wroteBased on observation, interview, and record review conducted during the recertification and abbreviated surveys (#2583366), the facility did not ensure that activities of preference and interest were available and designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community for one (1) of one (1) resident (Resident #20) reviewed for behavior-emotional care and one (1) of three (3) residents reviewed for restraints (Resident #7). Specifically, 1) Resident #20 was observed on multiple occasions wandering in the hallways of the unit and not participating in activities; 2) Resident #7 missed an activity that was held off the unit because the activities staff was unable to transfer the resident from an enclosed frame walker to a wheelchair.

Inspectors wroteBased on observation, interview, and record review conducted during the recertification and abbreviated surveys (#2583366) the facility did not ensure sufficient staff to provide services to maintain the highest practicable physical, mental and psychosocial well-being as per individualized care plan for one (1) of one (1) resident (Resident #20) reviewed for behavior and emotional care. Specifically, ongoing monitoring/supervision and thirty-minute checks were not consistently implemented for Resident #20 with a history of wandering and defecating/urinating in inappropriate places.

Inspectors wroteBased on record review and interviews conducted during an abbreviated survey (NY00384916), the facility did not ensure that comfortable and safe temperature levels were maintained in all areas during a heat emergency, when the air conditioning unit on one unit (Dogwood), located on the first floor of the building, was not functional on 06/23/2025. Specifically, the facility could not provide documentation that temperatures in resident rooms were adequate or comfortable during the breakdown of the air-conditioning system from 06/23/2025 to 06/24/2025. The air-conditioning was restored to residents' rooms on 06/24/2025 at 3:00 PM. The Administrator stated that they did not check resident room temperatures, as this was not part of the facility's policy. Since the hallway temperatures on Dogwood were within regulation, the air-conditioning issue was not reported as a heat emergency.

Inspectors wroteBased on record review and interviews during an abbreviated survey (NY00357873, NY00372738, NY00373759, NY00339079), the facility did not ensure sufficient nursing staffing to attain or maintain the well-being of each resident. Specifically, 1) upon review of the staffing schedule for multiple days and on all three shifts of staffing for each floor for February 2025, March 2025 and April 2025, the facility did not provide adequate staffing to meet the needs of the residents and were staffed below their minimum staffing levels on many occasions. 2)

Inspectors wroteBased on observation and interviews conducted during the abbreviated survey (NY00339079, NY00357873, NY00372568, NY00373759, NY00337630, NY00354632, NY00364043, NY00372738) from 4/21/25 to 4/23/25, the facility did not ensure that resident's dignity was maintained. 1) Specifically, residents on Apple unit were observed eating lunch and dinner meals on the unit hallways and residents waited a long time for assistance with eating; and 2) Certified Nurse Aide #20 referred to Resident #13 who required assistance with eating as a feeder and Activities Leader #4 referred to Resident #17 as a feeder in the presence of other residents.

Inspectors wroteBased on observations, record review, and interviews conducted during an abbreviated (NY00372738, NY00373759) surveys, for 2 of 8 residents (#5 and #4) reviewed for activities of daily living, it was determined the facility did not ensure residents who were unable to carry out ADLs received the necessary services to maintain good nutrition and personal hygiene. Specifically: 1.) There was no documented evidence in the February 2025 Certified Nurse Aide Accountability Record that Resident #5 was toileted on the day or evening shift for 2/14/25 2.) Resident #4 was observed waiting over an hour for assistance with eating, after the meal was delivered.

Inspectors wroteF684 Based on record review and interview during an abbreviated survey (NY 00372568) the facility did not ensure that residents received treatment and care in accordance with professional standards of practice for 1 out of 3 residents (Resident # 8) reviewed for medications. Specifically, Resident #8 had a seizure disorder, the immediate-use seizure medication was not transcribed from the Hospital Discharge Summary and not available when the resident had a seizure, resulting in the resident being transferred to the hospital for treatment.

Inspectors wrote2). Resident #12 had diagnoses Alzheimer's disease, dementia and depression. An Annual Minimum Data Set (MDS) dated [DATE] documented the resident had severely impaired cognition and was dependent on staff with all activities of daily living. A physician order dated 11/26/24 documented to administer Baclofen 5 milligrams give 0.5 tablet (2.5 milligrams) 2 times per day, every day at 10 AM and 6 PM. Nurse's Progress Notes dated 12/4/24 documented the resident's family member was concerned that Baclofen might be making the resident lethargic. Registered Nurse Unit Manager #1 spoke with Nurse Practitioner #1 and Baclofen 2.5 milligrams was changed to once daily from twice daily. A physician order dated 12/4/24 documented to administer Baclofen 5 milligrams, give 0.5 tablet (2.5 milligrams) once daily. [...]

Inspectors wroteBased on observation, interview and record review conducted during the Recertification Survey and Abbreviated Surveys (NY00354632, NY00357873, NY00337630, NY00372738, NY00372568, NY00373759, NY00364043, NY00339079) 4/21/25 to 4/23/25, the facility did not ensure one of five residents (Resident #11) were fed by staff members who completed a State-approved training course to assist residents in eating or drinking as required by regulations. Specifically, the facility was not able to provide documentation that Unit Assistants successfully completed a State approved training course for one Resident Assistants (Unit Assistant #26) observed feeding Resident #11 during a lunch meal.

Inspectors wroteBased on observation and interviews conducted during the abbreviated survey (NY00339079, NY00357873, NY00372568, NY00373759, NY00337630, NY00354632, NY00364043, NY00372738) conducted 4/21/25 to 4/23/25, the facility did not ensure infection control prevention practices were maintained to prevent the development and transmission of communicable diseases and infection and did not ensure there was a system for preventing, identifying, reporting, investigating, and controlling infection and communicable disease for all residents. Specifically, 1) facility staff were observed entering and exiting a contact and droplet isolation room (Resident #14) without donning and doffing personal protective equipment or performing hand hygiene. [...]

Inspectors wroteBased on record review and interviews during an abbreviated survey (NY00345900, NY00332503), the facility did not ensure that residents receive treatment and care in accordance with professional standards of practice for 12 out of 39 residents reviewed for identification bands. Specifically, during an observation on 11/12/2024 there were 12 residents on the Apple unit observed without identification bands in place.

Inspectors wroteBased on record review and interviews during an abbreviated survey (NY00345900, NY00332503), the facility did not ensure sufficient nursing staffing to attain or maintain the well-being of each resident for 39 residents on Unit A as determined by the facility nursing coverage plan as necessary to meet the needs of the residents.

Inspectors wroteBased on record review and interviews during an abbreviated survey (NY00345900, NY00332503) the facility did not ensure medications were administered in accordance with the prescriber's order or in accordance with professional standards for 3 out of 3 residents (Resident #1, Resident #2, Resident #3) reviewed for medication administration. Specifically, (1) Resident #1 had an order for the medication Depakote sprinkles, for their seizure disorder, and was administered their medication outside of the regulated time of an hour before or an hour after the scheduled time on 10/30/2024, 11/7/2024, 11/11/2024 and 11/12/2024. There was no documented evidence that the physician was made aware of the medication being administered late. [...]

Inspectors wroteBased on record review and interviews during an abbreviated survey (NY00345900, NY00332503), the facility did not ensure the residents environment remained free of accident hazards as is possible and that each resident received adequate supervision to prevent accidents for 2 out of 3 (Residents #2, #3) residents reviewed for accidents. Specifically, (1) Resident #2 who had history of falls and required moderate assistance for transfers had falls from their wheelchair on 8/3/2024, 8/8/2024, 8/30/2024, 9/14/2024, 9/29/2024 with no injuries; (2) Resident #3 had unwitnessed falls on 8/7/2023, 11/14/2023, 1/5/2024 and 1/10/2024 with minor injuries. There was no documented evidence that new interventions were implemented to prevent further falls and care plans were not updated on each occurrence for both Residents #2 and #3.

Inspectors wroteBased on record review and interviews during an abbreviated survey (NY00345900), the facility did not ensure that a resident with urinary and bowel incontinence received appropriate treatment and services to prevent urinary tract infections. This was evident for 1 out of 3 residents (Resident #1) reviewed for incontinence. Specifically, Resident #1 who was always incontinent of bladder and bowel functions and dependent on direct care staff for cares was diagnosed with a urinary tract Infection on 5/7/2024 and 9/9/2024. Review of Resident #1's certified nurse accountability reports for May 2024, June 2024, July 2024, August 2024, and September 2024 revealed numerous occasions where there was no documented evidence of direct care staff providing bladder and bowel incontinence care.

Inspectors wroteBased on record review and interviews during an abbreviated survey (NY00345900, NY00332530) the facility did not ensure a facility-wide assessment documented what resources are necessary to care for its residents competently during day-to-day operations including nights and weekends. The assessment did not include a review of individual staff assignments and systems for coordination and continuity of care for residents within and across the staff assignments.

Inspectors wroteBased on review of facility records, observation and interview during the recertification and abbreviated surveys (#NY00311199), from [DATE] through [DATE], it was determined 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 7 of 7 staff (Training Nurse Aide (TNA) #1-#7) reviewed for training. Specifically, TNAs were employed by the facility and functioned in the role of a nurse aide for greater than 4 months without receiving nurse aide certification.

Inspectors wroteBased on staff interview and review of facility records during the recertification and abbreviated surveys (NY311199) form 10/17 to 10/25/23, it was determined the facility did not ensure each certified nurse aide received twelve hours of in-service education per year, based on their individual performance review for 4 of 8 CNAs (CNA #8, #9, #10 and #11) reviewed for inservices. Specifically, CNA #8 lacked 6 hours of training; CNA #9 lacked 10 hours of training; CNA #10 lacked 8.5 hours of training, and CNA #11 lacked 7 hours of training; and all 4 CNAs lacked an annual performance evaluation. Finding Include: Review of the facility records for in-service education, provided by the Infection Control Nurse/Educator (IP) #1, revealed: - CNA #8 received 6 hours of in-service in 2023, and the last performance evaluation was completed 12/12/20. [...]

Inspectors wroteBased on observation, interview, and record review during the recertification survey conducted 10/17/23 through 10/25/23, the facility did not ensure drugs and biologicals were stored in accordance with currently accepted professional principles for 2 of 4 medication carts (Cedar and Apple). Specifically, medications were not stored in a clean environment on medication carts located on the Cedar and Apple units and undated/expired drugs and biologicals were discovered on medication carts of the Cedar and Apple unit.

Inspectors wroteBased on observation and interview conducted during a recertification survey conducted 10/17/23 through 10/25/23, the facility did not ensure that food was stored, prepared, distributed, and served in accordance with professional standards for food safety. Specifically, food items in the walk in refrigerator and the cook's refrigerator were unlabeled and undated. The rack designated for dry pans was wet.

Inspectors wroteBased on observation, record review and interview conducted during a recertification survey, the facility did not ensure for 1 of 5 residents (Resident #62), reviewed for activities of daily living, that care was provided in a manner to maintain dignity. Specifically, the urinary (Foley) catheter bag for Resident #62 was not concealed to prevent direct observation by other residents and their families.

Inspectors wroteBased on observations, record reviews and interviews during the recertification survey from 10/17/23-10/25/23, the facility did not ensure that the call bell system was accessible for 7 (Residents #115, #60, #105, #109, #132, #72 and #12) of 12 residents reviewed for Environment. Specifically, multiple observations revealed that call bells designated for Residents #115, #60, #105, #109, #132, #72 and #12, were not within the resident's reach.

Inspectors wroteBased on record review and interview conducted during the recertification and abbreviated surveys (# NY00317914) from 10/17 to 10/25/23, the facility did not ensure all injuries of unknown origin were thoroughly investigated and reported to the New York State Department of Health (NYSDOH) for 1 of 2 residents reviewed for abuse. Specifically, Resident #449 reported an unwittnessed fall and broken arm that was not thoroughly investigated to rule out abuse.

Inspectors wroteBased on observation, interview and record review conducted during the recertification survey from 10/17/23 to 10/25/23, the facility did not ensure that each resident who was unable to carry out activities of daily living (ADL) received the necessary care and services to maintain good personal hygiene for one (Residents #64) of five residents reviewed for ADL's. Specifically, Resident #64 was observed on multiple occasions with urine-soaked pants and on one occassion was observed not out of bed as planned.

Inspectors wroteBased on observation, record review, and interview during the recertification and abbreviated (NY00312435, NY00323395) surveys conducted 10/17/232023 - 10/25/2023, the facility did not ensure that residents received treatment and care in accordance with professional standards of practice for 3 of 8 residents (Resident #23, #299, and #105) reviewed for quality of care. Specifically, 1) Resident #23, had a physician order for Clonazepam (anxiety medication) and received an incorrect dose. 2) Resident #299 was sent to a medical appointment without an aide and the consultant physician refused to see the resident without an aide. 3) Resident #105 was administered crushed medications without a physician's order.

Inspectors wroteBased on record review and interview conducted during a recertification survey, the facility did not ensure that adequate supervision was provided to prevent accidents for 1 of 9 residents (Resident #302) reviewed for accidents. Specifically, Resident #302 who was assessed at high risk for falls on admission and was observed attempting to stand up from their wheelchair without staff assistance or redirection.

Inspectors wroteBased on observations, record review, and interviews conducted during the recertification survey from 10/17/23 to 10/25/23, the facility did not ensure a medication error rate of no more than 5%, during a medication administration observation, when 3 of 25 opportunities (12%) resulted in error and impacted 2 of 6 residents (Resident #132 and #136). Specifically, 1) Resident # 132 was administered Metoprolol Extended Release Tablet crushed instead of whole, and 2) Resident #136 was administered medication through a feeding tube without flushing between 2 medications.

Inspectors wroteBased on record review and interviews during the Recertification Survey and abbreviated survey (NY00323395) the facility did not ensure that each resident's representative was informed about appointments for 1 of 2 (Resident # 299) residents reviewed for notification. Specifically, Resident #299 was not seen at an orthopedic appointment due to not having an escort, and family was not contacted to accompany resident.

Inspectors wroteBased on observation, record review and interview conducted during a recertification and abbreviated (NY00323392) survey, the facility did not implement a person-centered care plan with measurable objectives, time frames and appropriate interventions based on comprehensive assessments for 1 of 5 residents (Resident #299) reviewed for activities of daily living. Specifically, for Resident #299 there was a non-compliant care plan for the TLSO back brace, which had no documented goals or interventions.

Inspectors wroteBased on observation, record review and interview conducted during an Extended Survey (#NY000264371), the facility was not administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. Specifically, the administrator failed to have a system in place for monitoring/inspecting the condition of hoyer pads and indicating which staff would be responsible for monitoring/inspecting the hoyer pads. The Findings Are: Facility Policy and Procedure titled Mechanical Lift revised August 2018 indicates all staff must assure that all hoyer slings are in good repair. If sling is noted to be in disrepair it must be taken out of service. [...]

Inspectors wroteBased on observation, record review and interviews conducted during a recertification survey, the facility did not provide and maintain an infection control program to help prevent the transmission of communicable diseases and infections. Specifically, (1) the staff did not consistently apply personal protective equipment (PPE) upon entry to a room where a resident on contact-based precautions resided and (2) equipment used for transferring residents was observed being dragged on the floor. This was evident for 1 of 1 residents reviewed for infection control (Resident #31) and during a facility observation on 1 of 4 units (Apple).

Inspectors wroteBased on interview and record review conducted during a recertification survey, the facility did not ensure that the nurse aides were provided the required hours of training and annual in-service training on dementia care management and resident abuse prevention to ensure safe delivery of care. This was evident for 10 of 10 Certified Nursing Aides (CNAs # 3, 4, 5, 6, 7, 8, 9, 10, 11, 12) reviewed for nurse aide training.

Inspectors wroteBased on record review and interview conducted during a recertification survey, the facility did not ensure that care and services were provided in accordance with the residents' care plan for 1 of 1 resident (Resident #95) reviewed for physical restraints; for 1 of 3 residents reviewed for hospitalization/quality of care (Resident #24); and for 1 of 1 resident reviewed for dialysis (Resident #140). Specifically, the facility did not: (1) ensure that an assistive device (Velcro seatbelt) used to prevent the resident from falling off a chair was released in accordance to the physician's order. (2) address Resident #24's ongoing weight gain; (3) consistently maintain ongoing communication with the dialysis center regarding the care of Resident #140 who was undergoing dialysis treatment

Inspectors wroteBased on interview and record review conducted during a recertification survey, the facility did not re-evaluate the person-centered care plan and develop appropriate interventions for 1 of to address changes in the resident's current health status. Specifically, a care plan for constipation was not revised to address issues related to a resident's recent hospitalization. This was evident for 1 of 1 resident (#140) reviewed for constipation /quality of life. The finding is: Resident #140 was admitted to the facility on [DATE]. The current diagnoses included End Stage Renal Disease, Dehydration and Constipation. The Significant Change Minimum Data Set (a resident assessment and screening tool) dated 6/28/18 indicated the resident's bowel pattern did not include constipation, cognitively intact, and required extensive assistance of one person for most aspects activities of daily living. [...]

Inspectors wroteBased on observation, interview and record review conducted during a recertification survey, the facility did not ensure for 1 of 1 resident (Resident #31) reviewed for tube feeding that the necessary care was provided to ensure sufficient fluid intake in accordance with the physician's order. Specifically, the facility did not ensure that additional water (automatic water flushes) for hydration was administered in accordance with the physician's order.

Inspectors wroteBased on interview and record review conducted during a recertification survey, the facility did not ensure that there was adequate indication for initiating and continuing an antipsychotic medication used to treat the behavioral symptoms of 1 of 5 residents reviewed for unnecessary medications (Resident #31). Specifically, (1) the clinicians assigned to the care of the resident did not consider the diagnosis of a urinary tract infection as a possible cause for the change in the resident's behavior prior to initiating the use of Zyprexa to address this change; (2) specific behaviors were not documented quantitatively and qualitatively to assess the effectiveness and determine the need for ongoing use of the medication; [...]

Inspectors wroteBased on observation and interviews conducted during a recertification survey the facility did not ensure that medications were stored and labeled in accordance with currently accepted professional standards. Specifically, 1 of 4 medication carts (Birch Unit) reviewed for medication storage, one insulin pen and 2 insulin vials were observed to be opened and undated, and one insulin vial was observed to be opened, undated and unlabeled. The finding is: Observation of medication storage was conducted on 7/23/18 from 4:15 to 4:45 PM on the Birch Unit low side and the following were noted: - One opened, undated vial of Humalog insulin; - One opened, undated vial of Lantus vial; - One opened, undated Levemir FlexTouch insulin pen, and - One opened, unlabeled vial of Lantus. The manufacturer's recommendation stated that Humulin vials in use must be used within 28 days or be discarded; [...]

Inspectors wroteBased on observation and interview conducted during a recertification survey, the facility did not ensure that food items kept in resident refrigerators were stored to prevent potential for food borne illness on 2 out of 4 resident units Cedar and Dogwood) . Specifically, foods brought in from the outside were not properly labeled and dated.