The Grand Rehabilitation and Nursing at Pawling

Inspectors wroteBased on observation, record review and interviews during the recertification and abbreviated surveys (NY00351988), the facility failed to ensure residents received treatment and care in accordance with professional standards of practice for one (1) of four (4) residents (Resident #217) reviewed for pressure ulcers. Specifically, Resident #217 reported ongoing loose bowel movements and there was no documented evidence of clinical monitoring and collection of stool for Clostridium Difficile as planned in the 7/22/2024 Nurse Practitioner progress note, and no documented evidence that stool for Clostridium Difficile (a bacterium that causes an infection of the colon) and a Complete Blood Count/Comprehensive Metabolic Panel were collected as planned in the 7/24/2024 Nurse Practitioner progress note. [...]

Inspectors wroteBased on record review and interviews conducted during the Recertification and Abbreviated surveys (NY00339190) from 06/10/25 to 06/17/25, the facility did not ensure there was sufficient nursing staff to attain or maintain the highest practicable physical and psychosocial well-being of each resident. Specifically, the facility did not provide adequate nurse staffing per the Facility Assessment Staffing Plan to meet the needs of the residents on sixty-nine of ninety days reviewed. This was evidenced by the nurse staffing schedules dated April 26, 2024, May 7, 2024, December 1 through December 31, 2024, weekends from January 1, 2025 through March 31, 2025, and May 10-June 10, 2025. [...]

Inspectors wroteBased on observations, interviews, and record reviews during the Recertification and Abbreviated Surveys (NY00339190, NY00364897, NY00368159, NY00372669, NY00377396, NY00356909, and NY00373290) from 6/10-6/17/2025, the facility did not ensure that residents unable to carry out activities of daily living received the necessary services to maintain grooming and personal hygiene for 9 of 9 residents (Residents #46, #14, #74, #216, #364, #214, #78, #314, #165, and 13) reviewed for Activities of Daily Living and 3 additional residents (Residents #61, 76, and 6) observed during the sufficient staffing task. Specifically, 1) Resident # 46 was not provided timely incontinence care and was not gotten out of bed daily. 2) Resident #14 was not provided consistent incontinence care and showers. [...]

Inspectors wroteBased on observation, interview, and record review conducted during the recertification and abbreviated (NY00356909, NY00339190) surveys from 6/10/25 to 6/17/25, the facility did not ensure resident's right to a safe, clean, comfortable, and homelike environment. Specifically, 1) Maintenance Care Logs dated January 2024 to present documented more than five hundred (500) reports of television and television remote controls not working properly and many not repaired timely. Additionally, Resident #314's family reported during April and September 2024 visits Resident #314 did not have a functioning television in their room, and 2) the closet door in Resident #39's room had broken hinges which prevented proper attachment.

Inspectors wroteBased on interview, and record review conducted during the recertification and abbreviated surveys (NY00364897) from 6/10/25 to 6/17/25, the facility did not ensure each resident's right to file a grievance and/or that prompt efforts were made to resolve a grievance for one of six residents (Resident #14) reviewed for Personal Property. Specifically, there was no documented evidence that a grievance was filed an investigation conducted and/or a grievance was resolved when Resident 14 reported to staff they were missing a bag that contained their license, gift cards, and some cash and multiple clothing items.

Inspectors wroteBased on record review and interview during an abbreviated survey (NY00348469, NY00349271) the facility did not ensure a resident was free from physical and verbal abuse from a staff member for 1 of 3 residents reviewed for abuse, neglect, or mistreatment was free from verbal abuse. Specifically, on 7/16/2024, Resident #2 reported that a Certified Nurse Aide #1 that provided care pulled their hair, hit and pulled their thumb. The incident was witnessed by the residents' roommate (Resident #3). In addition, Certified nurse Aide #5's statement revealed that when they walked into Resident #2's room, they found Resident #2 crying and Certified Nurse Aide #1 was telling Resident #2, I am a serious person, and you are racist.

Inspectors wroteBased on record review and interviews conducted during an abbreviated survey (NY00326926), the facility did not ensure a resident received treatment and care in accordance with professional standards of practice. This was evident for 1 of 3 Residents (Resident #1) reviewed for quality of care. Specifically, the facility did not ensure a endocrinology consult recommendation on 10/17/2023, to start an oral anti diabetic medication (Glipizide) was completed. Resident #1 was discharged on 3/21/2024. The recommendation from the nephrologist was not carried out at the time of discharge.

Inspectors wroteBased on observation and interviews during the Recertification survey conducted from 4/4/23 to 4/13/23, the facility failed to maintain a safe, clean, comfortable, and home-like environment for 1 of 3 resident units (Unit 200) and 1 of 9 resident (Resident #358) reviewed for accidents. Specifically, on the 200-unit there were multiple zip ties found (some with sharp edges) attached to residents' bed frames.

Inspectors wroteBased on interviews and record review during a Recertification Survey conducted 4/4/23-4/13/23 the facility failed to provide a safe and appropriate discharge for one of four residents (Resident #105) reviewed for discharge. Specifically, Resident #105 who was found smoking in a non-smoking facility was discharged from the facility without a physician order. Additionally, prior to discharge there was no documented evidence in Resident #105's Electronic Medical Record (EMR) of the facility efforts in meeting the resident's smoking needs and/or smoking cessation prior to the 3/7/23.

Inspectors wroteBased on interviews and record review during Recertification and Abbreviated Surveys (NY00308264 and NY00312103), conducted from 4/4/23-4/13/23, the facility did not ensure that the Office of the State Long Term Care Ombudsman was notified of the transfer/discharge for four of six residents (Residents #25, 31, 208 and 209) reviewed for hospitalization and one of four residents (#105) reviewed for discharge.

Inspectors wroteBased on interview and record review conducted during the recertification survey and abbreviated survey from 4/04/23 through 4/13/23 (NY00308264, NY00312103), it was determined that for 3 of 6 residents (#31 #208 and #209) reviewed for hospitalizations, the facility failed to ensure that the resident or the resident's representatives were notified in writing of the facility's Bed Hold Policy. Specifically, the residents were transferred to the hospital and the facility could not provide evidence that a written notice of the facility's Bed Hold Policy was provided to the residents or the resident's representatives.

Inspectors wroteBased on interviews and record review during a Recertification Survey conducted 4/4/23-4/13/23, the facility did not ensure that a person focused comprehensive care plan was developed and implemented to meet a resident's medical, nursing, and mental and psychosocial needs for one of nine residents (Resident #105) reviewed for accidents. Specifically, a care plan was not developed for Resident #105 with a history of smoking and was found smoking outside the nonsmoking facility on 3/2/23.

Inspectors wroteBased on interview and record review conducted during the Recertification and Abbreviated surveys (NY00310035), the facility did not provide the necessary care and services to address psychiatry follow up for 1 of 6 residents (Resident #207) reviewed for unnecessary medications. Specifically, Resident #207 was on antipsychotic medications, refused medications, exhibited behavioral disturbances, and was not followed up by psychiatry as planned.

Inspectors wroteBased on record review and interview during the Recertification Survey conducted from 4/4/23-4/13/23 the facility did not ensure the residents environment remained free from accident hazards and residents received adequate supervision to prevent accidents for one of nine residents (Resident #105) reviewed for accidents. Specifically, Resident #105 with a history of smoking and was found smoking outside the facility on 3/2/23. Additionally, Resident #105 was not adequately supervised and care plan interventions were not put in place to address the resident's smoking behaviors.

Inspectors wroteBased on interviews and record reviews during the Recertification Survey conducted from 4/4/23-4/13/23, the facility did not ensure development of policies and procedures for the monthly drug regimen review that included time frames for the different steps in the process when an irregularity was identified for one of six residents (Resident #28) reviewed for unnecessary medications. Specifically, pharmacy recommendations for Resident #28 were not addressed by medical providers.

Inspectors wroteBased on observation, interview and record review during a recertification survey conducted from 4/4/23-4/13/23, the facility did not ensure that pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals met the needs of each resident on two observed occasions. Specifically, 1) 1 pill was observed on the bedside table of Resident #42; and 2) an observation was made of a medicine cup with pills on a medication cart not kept under direct observation of authorized staff in the presence of Resident #67 who had wandering behaviors.

Inspectors wroteBased on observations, record reviews and interviews conducted during the recertification and abbreviated surveys (NY00313274), the facility did not ensure that staff followed proper hand hygiene and had access to Personal Protective Equipment (PPE) to prevent cross contamination and the spread of infection. Specifically, 1) hand hygiene was not observed for Residents #88, #60, #22, during the lunch meal observation. 2) Hand hygiene was not observed during and after a wound dressing change for Resident #34. 3) The PPE carts with clean gowns and masks were observed to be stored inside the resident rooms for Residents #79, #96, #34, and #57, preventing staff from donning a gown before entering an isolation room.

Inspectors wroteBased on record reviews and interviews conducted during a recertification and survey the facility did not ensure the Certified Nurse Aides (CNAs) were provided the required 12 hours of training and annual in-service training on dementia care management to ensure safe delivery of care. This was identified for 9 of 10 CNAs (CNAs #2, 4, 5, 6, 7, 8, 9, 10, and 11) reviewed for nurse aide training. Specifically, the facility was unable to provide evidence that CNAs #2, 4, 5, and 10 were provided 12 hours of mandatory annual training, and CNAs #6, 7, 8, 9, and 11 were provided the mandatory training in dementia care.

Inspectors wroteBased on observation, interview and record review conducted during a recertification survey, the facility did not ensure for 1 of 5 residents (#40) reviewed for Pressure Ulcer/Injury and 1 resident (#75) reviewed for Respiratory Care that a Plan of Care with measurable goals, time frames and interventions was developed and implemented to address the resident's assessed medical needs.

Inspectors wroteBased on observation, interview and record review conducted during the recertification survey, the facility did not ensure that infection control policies and procedures were followed. Specifically, 1) a urinary drainage bag was observed lying on the bed of Resident #95 2) a urinary drainage bag was observed touching the floor on two occasions (Resident #95) 3) two Licensed Practical Nurses (LPNs) did not follow proper hand hygiene during wound care observations.

Inspectors wroteBased on observation, interview and record review during a recertification survey, the facility did not ensure that food was stored and prepared under sanitary conditions. Specifically, (1.) the thermometer used to monitor the temperature of the walk-in freezer did not reflect acceptable temperatures and no corrective action was taken to use an accurate thermometer; (2.) dietary staff did not observe proper hand hygiene while performing tasks in the kitchen; (3.) all canned goods available for use did not have uncompromised seals; and (4.) all containers of food were not stored off the floor.

Inspectors wroteBased on interview and record review conducted during a recertification survey, the facility did not ensure the accuracy of the MDS (Minimum Data Set; a resident assessment and screening tool) for 1 of 4 residents reviewed for accidents (#266). Specifically, the comprehensive 5-day Significant Change MDS with a reference date of 11/22/17 did not reflect an incident of a fall sustained by the resident on 11/17/17 during the assessment period. The MDS Section J1800 Steps for Assessment states that the facility must review all available sources for any fall since the last assessment, no matter whether it occurred while out in the community, in an acute hospital, or in the nursing home. The nursing home must review incident reports, fall logs and the medical record (physician, nursing, therapy and nursing assistant notes.

Inspectors wroteBased on observation, interview and record review conducted during a recertification survey, the facility did not ensure for 1 of 1 resident (#166) reviewed for constipation that a plan of care with measurable goals, time frames and interventions was developed to address the resident's assessed medical needs. Specifically, dietary interventions to address constipation were not included in the resident's plan of care to help promote bowel regularity and decrease dependence on medications.

Inspectors wroteBased on observation, interview and record review conducted during a recertification survey, the facility did not ensure that a resident's plan of care was followed for 1 of 6 residents (#106) observed during a medication pass. Specifically, resident #106 was administered a high protein caloric supplement, during a medication pass observation which was not part of the resident's plan of care.

Inspectors wroteBased on observation, interview and record review, conducted during a recertification survey, the facility did not ensure for 1 of 1 resident (#166) reviewed for constipation that appropriate care in accordance with professional standards of practice was provided to the resident. Specifically, (1.) the physician's orders for the treatment of constipation was not consistently implemented and (2.) the bowel regimen planned and implemented to promote bowel regularity for the resident did not include dietary interventions to help promote bowel regularity and decrease dependence on medications.

Inspectors wroteBased on interviews and record review conducted during a recertification survey, the facility did not ensure that for 1 of 5 residents (#73) reviewed for unnecessary medications that an antipsychotic medication was not used at an excessive dose. Specifically, the dose of Risperdal, an antipsychotic medication, was increased after two behavioral incidents that were not life-threatening to resident or others and for which staff did not make any attempt to determine the root cause.

Inspectors wroteBased on observation, interview and record review conducted during a recertification survey, the facility did not ensure that its medication error rate did not exceed 5% for 2 of 6 residents (#53 and #106) observed during a medication pass for a total of 30 observations. This resulted in a medication error rate of 6.6 percent.