The Grand Rehabilitation and Nrsg at Chittenango

Inspectors wroteBased on observations and interviews during the recertification survey conducted [DATE]-[DATE], the facility did not ensure drugs and biologicals were labeled and stored in accordance with currently accepted professional principles for one (1) of two (2) medication rooms (Units A and B medication rooms) and one (1) of one (1) medication carts (Unit A South) reviewed. Specifically, the Unit A medication room had medications stored on the floor, discontinued medications were placed on a shelf with a resident's unlabeled personal medications stored in an emesis bag (used to collect vomit), and the medication refrigerator temperatures were out of range and contained frozen insulin pens; [...]

Inspectors wroteBased on observation, record review, and interview during the recertification survey conducted 9/22/2025-9/25/2025, the facility did not ensure food was stored, prepared, distributed, and served in accordance with professional standards in one (1) out of one (1) main kitchen and for two staff (Dietary Aide #5 and Dietary Aide #6). Specifically, in the main kitchen staff did not wash their hands before preparing food; food was not labelled and dated; and food contact surfaces were not sanitized appropriately. Additionally, Dietary Aide #11 and [NAME] #9 did not wear beard restraints during food preparation.

Inspectors wroteBased on observation, record review, and interview during the recertification survey conducted 9/22/2025-9/25/2025, the facility did not ensure residents had a means of directly contacting staff for assistance for one (1) of one (1) residents (Resident #9) reviewed. Specifically, Resident #9's call bell was out of reach and not accessible. Additionally, Residents #10, 24, 62's call bells were observed to be out of reach one day of survey and Resident #63's call bell was observed to be out of reach two days of survey.

Inspectors wroteBased on observations, record review, and interviews during the recertification and abbreviated (NY00495399) surveys conducted 9/22/2025-9/25/2025, the facility did not ensure residents who were unable to carry out activities of daily living received the necessary services to maintain good grooming, and personal and oral hygiene for one (1) of one (1) resident (Resident #22) reviewed. Specifically, Resident #22 had unclean hands, face, fingernails and clothing; disheveled hair; and an unclean wheelchair.

Inspectors wroteBased on observations, record review, and interviews during the recertification survey conducted 9/22/2025-9/25/2025, the facility did not ensure residents maintained acceptable parameters of nutritional status for two (2) of three (3) residents (Residents #2 and #8) reviewed. Specifically, Resident #2 had weight loss not addressed by the registered dietitian and there was no documented intervention implemented to prevent further weight loss, and Resident #8 was not supervised during self-administration of their tube feeding and was observed to be administering the incorrect amount. Additionally, Resident #8 did not have a physician order or a care plan to self-administer.

Inspectors wroteBased on record review and interviews during the abbreviated survey (NY00297623), the facility did not ensure residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and resident choices for 1 of 1 resident (Resident #5) reviewed. Specifically, Resident #5 had an unwitnessed fall, complained of pain the following morning, an x-ray was ordered, the x-ray was completed 10 hours after the resident complained of pain, and results were received 14 hours after they were ordered. Subsequently, the resident was hospitalized and was diagnosed with a right hip fracture. Additionally, the resident was not medicated for complaints of pain.

Inspectors wroteBased on observation, record review, and interview during the abbreviated survey (NY00303220) the facility did not ensure residents who were unable to carry out activities of daily living received the necessary services to maintain grooming and personal hygiene for 1 of 3 residents (Resident #1) reviewed. Specifically, Resident #1 was not assisted with toileting timely.

Inspectors wroteBased on record review and interviews during the recertification survey conducted 1/22/2024- 1/26/2024 the facility failed to ensure residents' advance directives were documented for 6 of 14 residents reviewed (Residents #172, #174, #222, #223, #224, and #320). Specifically, Residents #172, #174, #222, #223, #224, and #320 were admitted within the last 30 days (12/26/2023- 1/23/2024) and did not have physician orders for advance directives. Subsequently, during a cardiac emergency event, staff would not know Residents #172's, #174's, #222's, #223's, #224's, and #320's wishes for life-sustaining treatment. This placed Residents #172, #174, #222, #223, #224, and #320 at risk for the likelihood of serious harm or death that was Immediate Jeopardy.

Inspectors wroteBased on record review and interview during the recertification survey conducted 1/22/2024 through 1/26/2024, the facility did not provide the appropriate liability and appeal notices to Medicare beneficiaries for 3 of 3 residents (Residents #271, 272, and 273) reviewed. Specifically, Residents #271, #272, and #273 were discharged to home and were not provided with Notice of Medicare Non-Coverage (Centers for Medicare and Medicaid Services-10123) for Medicare Part A as required.

Inspectors wroteBased on observation, record review, and interviews during the recertification and abbreviated surveys (NY00298057, NY00320417, and NY00326044) from 1/22/2024-1/26/2024, the facility did not ensure residents were free from abuse for 2 of 5 residents (Residents #14 and #28) reviewed. Specifically, the facility did not implement plans to protect residents from abuse and prevent resident to resident abuse when Residents #14 and #28 did not have safety checks as planned and Resident #28 did not have a stop sign across their door as planned and continued to have access to their reacher device (a tool to grab out of reach items) after they hit someone with it and the plan was for the reacher to be removed.

Inspectors wroteBased on observation, record review, and interviews during the recertification and abbreviated (NY00321647 and NY00323860) surveys conducted 1/22/2024-1/26/2024, 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 4 residents (Residents #11 and #37) reviewed. Specifically, Resident #11 was not assisted with nail care and had food particles on their clothing; and Resident #37 was not assisted with personal hygiene and clothing changes.

Inspectors wroteBased on observation, record review, and interviews during the recertification survey conducted 1/22/2024-1/26/2024, the facility did not ensure a resident received respiratory care consistent with professional standards of practice for 1 of 1 resident (Resident #11) reviewed. Specifically, Resident #11 had a physician order for 2 liters of oxygen and received 1.5 liters and was observed not wearing oxygen as ordered.

Inspectors wroteBased on observation, interview, and record review during the recertification and abbreviated (NY00314269) surveys conducted 1/22/2024-1/26/2024, the facility did not establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of infection for 4 of 5 residents (Residents #7, #29, #64, and #270) reviewed. Specifically, Resident #64's wound care was completed without appropriate hand hygiene and precautions to prevent contamination of the wound or clean supplies; and Residents #7, #29, and #270 had their blood glucose (blood sugar) checked and the glucometer (device used to measure blood sugar levels using a droplet of blood) was not disinfected between use or disinfected with an appropriate high-level disinfectant.

Inspectors wroteBased on observation, interview, and record review during the recertification survey conducted 1/22/2024-1/26/2024, the facility did not maintain equipment in safe operating condition for the main kitchen and for 1 of 2 resident wings (B-unit). Specifically, the main kitchen hood exhaust fan was not functional; and there was no ice-dispenser machine available for resident use on the B-unit.

Inspectors wroteBased on observation, record review and interview during the recertification survey conducted from 8/16-8/19/21, the facility did not ensure 3 of 4 residents (Residents #20, 34 and 74) received the necessary services to maintain good grooming and personal hygiene. Specifically, Residents #20 and 34 were not assisted with timely nail care and shaving and Resident #74 was not assisted with shaving.

Inspectors wroteBased on observation and interview during the recertification survey conducted 8/16-8/19/21, the facility failed to maintain an effective pest control program so that the facility was free of pests and rodents for the main kitchen, the main dining room and 2 of 2 resident units (A unit and B unit). Specifically, fruit flies were observed on the walls and tiles near the dish washing area in the main kitchen, in resident rooms on A and B units, on ceiling tiles in the A and B Unit hallways, in the main dining room, around the nursing stations, and in nursing offices. This is evidenced by: The facility policy Pest Control dated 1/2021 documented the facility would implement a continuing and effective pest control prevention and monitoring program to maintain the facility as pest and rodent free as possible. [...]

Inspectors wroteBased on observation, record review and interview during the recertification survey conducted 8/16-8/19/21, the facility failed to maintain a safe, clean, comfortable and homelike environment for 2 of 2 nursing units (Units A and B). Specifically, observations included damaged walls, different colored paint, dried drips, duct tape on a wheelchair, and spackling on a wall throughout the nursing units and maintenance work orders were not reported or addressed timely. For Residents #34 and 74 the facility did not ensure a homelike environment with personalized décor. Resident #3 continued to reside in a room during repairs to the walls that included sheetrock replacement, mudding, and painting. Additionally, Resident #3's room had loose electrical outlets, loose curtain rods, and missing baseboards that were not repaired timely.

Inspectors wroteBased on record review and interview during the recertification survey conducted from 8/16/21-8/19/21, the facility failed to ensure that residents who require dialysis (a process of purifying the blood of a person whose kidneys are not working normally) receive such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 1 of 1 resident (Resident #42) reviewed. Specifically, the facility did not maintain ongoing communication and collaboration with the dialysis facility regarding Resident #42's dialysis care and services and proper infection control precautions required for the resident.