Citations Summary
Jun 2022 – May 202610 Inspections Conducted
3
No citations found
30% of all inspections
7
Resulted in citations
70% of all inspections
30 Total Citations — state avg: 41
Issued across those 7 inspections
20Standard Health
10Life Safety Code
Severity of Citations
How serious were those 30 citations?
0
Minor potential harm
All corrected ✓
0
No actual harm
None in this period
In plain language
- Across 10 inspections in the current reporting window, 3 found no citations at all; inspectors issued 30 citations in total.
- Of those, 20 were standard health citations (quality of care) and 10 were related to the Life Safety Code (fire protection).
- The state logged 172 complaints about this facility; 24 led to on-site inspections.
- The state has 3 formal enforcement actions (fines or stipulations) on record.
A citation is a rule violation noted by a state inspector. Most are corrected through a plan of correction; the sections below show each citation, its severity, and how the facility compares with the statewide average.
Provider Information
Type
Nursing Home
Operating Certificate
5828302N
County
Wayne
Phone
(315) 483-9118
Operated By
BVRNC Operating, LLC (For Profit)
DOH Regional Office
Western NY
Occupancy Rate
98%
Inspection Details
Surveys with Citations Only▼
Standard Health Citations
Food Procurement,store/prepare/serve-sanitary
Standard Health Citation — quality of care
Nutrition/hydration Status Maintenance
Standard Health Citation — quality of care
Resident Rights/exercise Of Rights
Standard Health Citation — quality of care
Residents Are Free Of Significant Med Errors
Standard Health Citation — quality of care
Life Safety Code Citations
Egress Doors
Life Safety Code Citation — NFPA requirements
Fire Alarm System - Testing And Maintenance
Life Safety Code Citation — NFPA requirements
Hazardous Areas - Enclosure
Life Safety Code Citation — NFPA requirements
Vertical Openings - Enclosure
Life Safety Code Citation — NFPA requirements
▼
Standard Health Citations
Investigate/prevent/correct Alleged Violation
Standard Health Citation — quality of care
▼
Standard Health Citations
Food Procurement,store/prepare/serve-sanitary
Standard Health Citation — quality of care
▼
Standard Health Citations
Reporting - National Health Safety Network
Standard Health Citation — quality of care
▼
Standard Health Citations
Accuracy Of Assessments
Standard Health Citation — quality of care
Activities Meet Interest/needs Each Resident
Standard Health Citation — quality of care
Care Plan Timing And Revision
Standard Health Citation — quality of care
Colostomy, Urostomy, Or Ileostomy Care
Standard Health Citation — quality of care
Drug Regimen Review, Report Irregular, Act On
Standard Health Citation — quality of care
Free From Unnec Psychotropic Meds/prn Use
Standard Health Citation — quality of care
Free Of Accident Hazards/supervision/devices
Standard Health Citation — quality of care
Physical Environment
Standard Health Citation — quality of care
Safe/clean/comfortable/homelike Environment
Standard Health Citation — quality of care
Treatment/svcs To Prevent/heal Pressure Ulcer
Standard Health Citation — quality of care
Tube Feeding Mgmt/restore Eating Skills
Standard Health Citation — quality of care
Life Safety Code Citations
Doors With Self-closing Devices
Life Safety Code Citation — NFPA requirements
Electrical Equipment - Testing And Maintenanc
Life Safety Code Citation — NFPA requirements
Electrical Systems - Essential Electric Syste
Life Safety Code Citation — NFPA requirements
Emergency Lighting
Life Safety Code Citation — NFPA requirements
Fire Drills
Life Safety Code Citation — NFPA requirements
Sprinkler System - Maintenance And Testing
Life Safety Code Citation — NFPA requirements
▼
Standard Health Citations
Free From Abuse And Neglect
Standard Health Citation — quality of care
▼
Standard Health Citations
Food Procurement,store/prepare/serve-sanitary
Standard Health Citation — quality of care
Severity Scale Reference
Level 0 — No Harm Potential
Level 2 — Minor Potential Harm
Level 3 — Actual Harm
Level 4 — Immediate Jeopardy
Complaints
Jun 2022 – May 2026Above state average. This facility received 153.6 complaints per 100 beds vs. a statewide rate of 57.4. 7 citations resulted from those complaints (6.2 per 100 beds vs. 5.3 statewide).
Total Complaints
172
55,669 statewide
Per 100 Occupied Beds
153.6
57.4 state avg
On-Site Inspections
24
7,566 statewide
Citations Issued
7
6.2 per 100 beds · avg 5.3
Facility-Reported Incidents
71%
55% statewide
| Citations by Category | This Facility |
|---|---|
| Administration | 0 |
| Dietary Services | 3 |
| Other Services | 2 |
| Physical Environment | 0 |
| Quality of Care | 2 |
| Resident Rights | 4 |
| Total | 11 |
Enforcement & Fines
Jun 2016 – May 20263 enforcement actions totaling $20,000 in fines over the reporting period. Resolved via Stipulation & Order agreements with the NY Department of Health where applicable.
October 3, 2022
$2,000
Stipulation & Order #NH-23-027 · Signed March 15, 2023
Reason: Quality of Care
Reason: Quality of Care
June 17, 2020
$8,000
Stipulation & Order #NH-21-099 · Signed May 11, 2021
Reason: Quality of Care
Reason: Quality of Care
February 15, 2019
$10,000
Stipulation & Order #NH-19-041 · Signed September 16, 2019
Reason: Multiple Deficiencies
Reason: Multiple Deficiencies