Taconic Rehabilitation and Nursing at Beacon

Inspectors wroteBased on record review and interviews during an abbreviated survey (NY00352881), the facility did not ensure a resident received care, consistent with professional standards of practice, to promote the healing of a pressure ulcers for 1 of 3 residents (Resident #1) reviewed. Specifically, (1) Resident #1 was admitted to the facility on [DATE] with a unstageable sacral wound measuring 6 x7cm. Physician orders and preventative measures ordered by the physician were not consistently provided by staff. There were omissions on the October 2023 treatment administration record on multiple days and shifts. Physician wound notes dated 10/24/2023 documented a sacral wound measured 12 x 6.5cm with 98% slough with non-blanchable peri wound with scant drainage; 2) preventative measures were not implemented according to the resident's care plan and/or physician's order. [...]

Inspectors wroteBased on observation, record review and interview conducted during the recertification survey from 6/24/2024 through 7/01/2024, the facility did not ensure for 3 of 4 residents (Residents # 322, # 101 and #86) reviewed for urinary catheters, that care was provided in a manner to maintain dignity. Specifically, Residents #322, #101, and #86 had urinary catheter drainage collection bags that were not concealed to prevent direct observation, by other residents and their families.

Inspectors wroteBased on interviews and record review conducted during the Recertification survey from 06/24/2024 to 07/01/2024, the facility did not ensure the resident and the resident's representative were given the opportunity to participate in the development and implementation of the residents person-centered plan of care. This was evident for 1 (Resident #41) of 32 total sampled residents. Specifically, the facility did not include the resident's representative during the planning of their care plan meeting as requested.

Inspectors wroteBased on record review and interviews conducted during the recertification survey from 6/24/2024-7/1/2024, the facility failed to ensure that for 1 of 26 residents, screened for mental disorder or intellectual disability, had an identification number documented on their pre-admission screening and resident review assessment prior to their admission to the facility. Specifically, Resident #420's electronic medical record revealed that the pre-admission screen and resident review (PASRR) assessment dated [DATE] did not include an identification number prior to admission.

Inspectors wroteBased on observation, interview and record review conducted during the recertification and abbreviated (NY00330557) surveys from 6/24/24 -7/1/24, it was determined for 2 of 6 residents (Residents #320 and #71) reviewed for Nutrition and Hydration, the facility did not ensure the residents were provided the necessary care to maintain an acceptable body weight. Specifically, 1) Resident #320 medical record documented a 24 pound weight gain and the medical provider was not made aware; the physician's orders documented daily weights but Resident #320's weight record did not reflect daily weights; and the facility did not have a system in place to accurately weigh, monitor and report weights. [...]

Inspectors wroteBased on observation, interview, and record review during recertification survey conducted 6/24/2024 - 7/1/2024, the facility did not ensure menus were followed for 2 of 2 residents (Resident # 61 and # 71) reviewed for Nutrition. Specifically, 1. Residents #61 received fish that was not documented on the meal ticket and 2. Resident # 71 had a meal ticket that documented 4 ounces of mashed potatoes and 4 ounces of enriched mashed potatoes, the tray had 4 ounces of mashed potatoes and Resident #71 did not receive nectar thick apple juice as indicated on the tray ticket.

Inspectors wroteBased on observation, record review and interviews conducted during a recertification survey (6/24/24-7/1/24), the facility did not ensure infection control prevention practices including hand hygiene, enhanced barrier precautions, and catheter care were maintained to help prevent the development and transmission of communicable diseases and infections for 4 ( #37,#61,#322, #86) of 32 sampled residents. Specifically, 1) Staff #11 (Licensed Practical Nurse) did not follow proper hand hygiene during a wound care treatment for Resident #37; 2) Enhanced barrier precautions were not implemented when Staff #9 (Registered Nurse) performed Resident #61's dressing change, and when Staff #8 (Physical Therapy Assistant) handled Resident #322's catheter drainage bag without gloves or a gown; and 3) Resident #86 urine catheter collection bag was observed on the floor.

Inspectors wroteBased on observations, interviews and record review during a Recertification Survey, the facility did not ensure residents have a right to a dignified existence for 3 of 3 residents screened for dignity. Specifically, Resident #77 was identified by a Certified Nursing Assistant (CNA) using a term that described a symptom of his/her medical condition, Resident #186 received services by a Radiology Technician who did not knock on the residents door before entering, identify himself or the anticipated procedure and Resident #9 who also received radiology services by a technician who entered the resident's room without identifying himself.

Inspectors wroteBased on interviews and record reviews during a Recertification Survey, the facility did not ensure that Comprehensive Care Plans (CCP) were reviewed and revised after each assessment and as needed for changes in the residents' care needs. Furthermore, the facility did not ensure residents/resident representatives were invited to participate in care planning meetings. Specifically, 1) Resident #11's Activities of Daily Living (ADL) Care Plan was last updated on 08/18/2020; 2) Resident #12's ADL Care Plan was last updated on 12/09/2020 and resident #12's daughter stated that she has not been invited to any care plan meetings; and 3) Resident #75 stated that he/she is not familiar with Care Plan Meetings. This was evident for 3 of 22 sampled residents.

Inspectors wrote2. Resident #124 was admitted to the facility on [DATE] with diagnoses including Hemiparesis, Cerebral Infarction, and aphasia (inability to speak). The admission MDS of 8/21/18 indicated the resident had severely impaired cognitive skill for daily decision making and required extensive assistance to being totally dependent on 1-2 person assistance for most activities of daily living. The Physician Orders (PO) form dated 9/5/18 included orders for Doppler examination of the right upper extremity, x-ray of the right hand, and elevate the right upper extremity. The PO order of 9/6/18 included the use of venodynes (a device placed around the legs that inflates and deflates to keep blood circulating in the legs to help prevent the formation of blood clots) and a hematology consult for a diagnosis of Acute RUE (Right Upper Extremity) DVT (Deep Vein Thrombosis). [...]

Inspectors wroteBased on interviews and record review conducted during the most recent recertification survey, the facility did not ensure that sufficient staff was available to meet the needs of residents on all units and on all shifts. This was evidenced by (1.) multiple residents reporting during confidential interviews and the group meeting of lack of Certified Nurse Aides (CNAs) to respond to call bells and provide assistance with activities of daily living; (2.) multiple nursing staff members reporting lack of sufficient staffing on all units; and (3.) analysis of the actual staffing schedule showing that on multiple occasions the facility was below its required levels for CNAs on all units.

Inspectors wroteBased on observation, interview and record review conducted during a recertification survey, the facility did not ensure that foods brought in from outside sources were stored according to professional standards of food safety practice on 2 of 4 facility units ([NAME] and [NAME]). Specifically, multiple containers of food brought in for residents by family members were observed to be out dated. The facility policy did not indicate how long the food could be kept in the refrigerators.

Inspectors wroteBased on observation, record review and interviews conducted during a recertification survey, the facility did not ensure that residents were free from physical restraints. It was determined for 1 of 1 resident (#96) reviewed for physical restraints that: (1) thorough assessment and re-evaluation were not conducted to address the use of a self-release seatbelt while in the wheelchair that may possibly restrict the resident's movement, and (2) the physician's order was not obtained to address the medical symptoms that may warrant the use of this device. The facility policy and procedure for Restraints, revised on 02/28/17, stated that the decision to apply a restraint required the collaborative opinion of the resident's physician, the resident/health care agent or responsible person, and appropriate interdisciplinary team members. [...]

Inspectors wroteBased on interview and record review conducted during a recertification survey, the facility did not ensure for 1 of 3 residents (#90) reviewed for hospitalization that the resident's representative was given a written notice of the facility bed hold policy upon transfer to the hospital. The finding is: Resident #90 was admitted to the facility on [DATE] with diagnoses including End Stage Renal Disease, Blindness on one eye, Hemiplegia right dominant side, and Diabetes Mellitus. The Annual Minimum Data Set (MDS; an assessment tool) dated 5/11/18 documented that the resident has moderately impaired cognition for daily decision making and was able to participate in assessment and goal setting. The nurses' note dated 8/7/18 documented that the resident returned from dialysis center. The dialysis was not completed due to inability to access the fistula (a venous access device). [...]

Inspectors wroteBased on observations, interviews, and record reviews conducted during a re-certification survey, it was determined for 1 of 1 resident (#124) reviewed for positioning and mobility that treatment and care was provided in accordance with professional standard of practice in order to meet the resident's physical, mental, and psychological needs. Specifically, the facility did not ensure that thrombo-embolic deterrent (TED) compression stockings were applied per physician's order to help prevent the formation of blood clots and improve blood circulation. The finding is: Resident #124 was admitted to the facility on [DATE] with diagnoses including Hemiparesis, Cerebral Infarction, and aphasia (inability to speak). The admission MDS (Minimum Data Set; [...]

Inspectors wroteBased on record review and interview conducted during a recertification survey, the facility did not ensure for 1 of 5 residents reviewed for unnecessary medications (#11) that monthly medication regimen reviews performed by the consultant pharmacist were consistently reviewed and acted upon by the attending physician or medical director. The finding is: Resident #11 was admitted with diagnoses including Psychosis, Alzheimer's disease and Congestive Heart Failure. The Quarterly MDS (Minimum Data Set; a resident assessment tool) dated 6/22/18 revealed the resident's BIMS score (Brief Interview for Mental Status) was 3 out of 15 which indicated that her cognition was severely impaired. This MDS assessment further revealed the resident was prescribed an antipsychotic (Seroquel), an antidepressant (Paxil), and a diuretic (Lasix) during the last seven days of the assessment period. [...]

Inspectors wroteBased on observation, record review and staff interview conducted during a recertification survey, the facility did not ensure that each resident's medication regimen was free from unnecessary medications for 1 of 5 resident (#11) reviewed for unnecessary medications. Specifically, the resident's behavior and response to the use of the antipsychotic medication (Seroquel) was not consistently monitored in order to justify the ongoing use of the medication. The finding is: Resident #11 was admitted on [DATE] with diagnoses including Psychosis, Alzheimer's disease and Depression. The Quarterly MDS (Minimum Data Set; a resident assessment tool) dated 6/22/18 revealed the resident's BIMS score (Brief Interview for Mental Status) was 3 out of 15 which indicated that her cognition was severely impaired. Review of the admission Physician's orders revealed an order for Seroquel 75 mg in the a.m. [...]

Inspectors wroteBased on observation and interview conducted during a recertification survey, the facility did not provide the housekeeping and maintenance services necessary to maintain a clean, comfortable and homelike environment for multiple residents on 4 of 4 resident units. Examples of conditions observed included, but are not limited to soiled carpeting, walls were scuffed and dirty, peeling wall paper, multiple radiators needed repainting, stained and dirty bathroom floor, non-working call bell, and soiled privacy curtain.