Citations Summary
Feb 2022 – Jan 202620 Total Citations — state avg: 23
Issued in the reporting period
15Standard Health
5Life Safety Code
Severity of Citations
How serious were those 20 citations?
0
Minor potential harm
All corrected ✓
0
No actual harm
None in this period
Inspection Details
Surveys with Citations Only▼
Standard Health Citations
Bowel/bladder Incontinence, Catheter, Uti
Standard Health Citation — quality of care
Care Plan Timing And Revision
Standard Health Citation — quality of care
Department Criminal History Review
Standard Health Citation — quality of care
Dispose Garbage And Refuse Properly
Standard Health Citation — quality of care
Drug Regimen Review, Report Irregular, Act On
Standard Health Citation — quality of care
Encoding/transmitting Resident Assessments
Standard Health Citation — quality of care
Food Procurement,store/prepare/serve-sanitary
Standard Health Citation — quality of care
Free From Abuse And Neglect
Standard Health Citation — quality of care
Free From Unnec Psychotropic Meds/prn Use
Standard Health Citation — quality of care
Increase/prevent Decrease In Rom/mobility
Standard Health Citation — quality of care
Infection Control
Standard Health Citation — quality of care
Infection Prevention & Control
Standard Health Citation — quality of care
Investigate/prevent/correct Alleged Violation
Standard Health Citation — quality of care
Menus Meet Resident Nds/prep In Adv/followed
Standard Health Citation — quality of care
Notify Of Changes (injury/decline/room, Etc. )
Standard Health Citation — quality of care
Qapi Prgm/plan, Disclosure/good Faith Attmpt
Standard Health Citation — quality of care
Quality Of Care
Standard Health Citation — quality of care
Reporting Of Alleged Violations
Standard Health Citation — quality of care
Request/refuse/dscntnue Trmnt;formlte Adv Dir
Standard Health Citation — quality of care
Requirements Before Submitting A Request For
Standard Health Citation — quality of care
Resident Records - Identifiable Information
Standard Health Citation — quality of care
Resident Rights/exercise Of Rights
Standard Health Citation — quality of care
Responsibilities Of Providers; Required Notif
Standard Health Citation — quality of care
Safe/clean/comfortable/homelike Environment
Standard Health Citation — quality of care
Self-determination
Standard Health Citation — quality of care
Life Safety Code Citations
Building Construction Type And Height
Life Safety Code Citation — NFPA requirements
Corridor - Doors
Life Safety Code Citation — NFPA requirements
Electrical Systems - Other
Life Safety Code Citation — NFPA requirements
Illumination Of Means Of Egress
Life Safety Code Citation — NFPA requirements
▼
Standard Health Citations
Reporting - National Health Safety Network
Standard Health Citation — quality of care
▼
Standard Health Citations
Behavioral Health Services
Standard Health Citation — quality of care
Free From Abuse And Neglect
Standard Health Citation — quality of care
Right To Be Free From Physical Restraints
Standard Health Citation — quality of care
▼
Standard Health Citations
Accuracy Of Assessments
Standard Health Citation — quality of care
Baseline Care Plan
Standard Health Citation — quality of care
Bedrails
Standard Health Citation — quality of care
Care Plan Timing And Revision
Standard Health Citation — quality of care
Develop/implement Comprehensive Care Plan
Standard Health Citation — quality of care
Encoding/transmitting Resident Assessments
Standard Health Citation — quality of care
Free From Abuse And Neglect
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
Infection Prevention & Control
Standard Health Citation — quality of care
Pain Management
Standard Health Citation — quality of care
Quality Of Care
Standard Health Citation — quality of care
Reporting Of Alleged Violations
Standard Health Citation — quality of care
Right To Be Free From Physical Restraints
Standard Health Citation — quality of care
Safe/functional/sanitary/comfortable Environ
Standard Health Citation — quality of care
Surety Bond-security Of Personal Funds
Standard Health Citation — quality of care
Life Safety Code Citations
Discharge From Exits
Life Safety Code Citation — NFPA requirements
Egress Doors
Life Safety Code Citation — NFPA requirements
Electrical Systems - Essential Electric Syste
Life Safety Code Citation — NFPA requirements
Electrical Systems - Other
Life Safety Code Citation — NFPA requirements
Exit Signage
Life Safety Code Citation — NFPA requirements
Hvac
Life Safety Code Citation — NFPA requirements
Illumination Of Means Of Egress
Life Safety Code Citation — NFPA requirements
Multiple Occupancies - Contiguous Non-health
Life Safety Code Citation — NFPA requirements
Physical Environment
Life Safety Code Citation — NFPA requirements
Smoking Regulations
Life Safety Code Citation — NFPA requirements
Sprinkler System - Installation
Life Safety Code Citation — NFPA requirements
Sprinkler System - Maintenance And Testing
Life Safety Code Citation — NFPA requirements
Stairways And Smokeproof Enclosures
Life Safety Code Citation — NFPA requirements
▼
Standard Health Citations
Reporting - National Health Safety Network
Standard Health Citation — quality of care
▼
Standard Health Citations
Reporting - National Health Safety Network
Standard Health Citation — quality of care
▼
Standard Health Citations
Infection Prevention & Control
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
Feb 2022 – Jan 2026Below state average. This facility received 35.4 complaints per 100 beds vs. a statewide rate of 55.0. 15 citations resulted from those complaints (5.4 per 100 beds vs. 3.0 statewide).
Total Complaints
98
55,221 statewide
Per 100 Occupied Beds
35.4
55.0 state avg
On-Site Inspections
8
8,103 statewide
Citations Issued
15
5.4 per 100 beds · avg 3.0
Facility-Reported Incidents
44%
55% statewide
| Citations by Category | This Facility |
|---|---|
| Administration | 1 |
| Dietary Services | 3 |
| Other Services | 0 |
| Physical Environment | 3 |
| Quality of Care | 9 |
| Resident Rights | 1 |
| Total | 17 |
Enforcement & Fines
Feb 2016 – Jan 20262 enforcement actions totaling $7,000 in fines over the reporting period. Resolved via Stipulation & Order agreements with the NY Department of Health where applicable.
May 26, 2023
$2,000
Stipulation & Order #NH-23-088 · Signed October 2, 2023
Reason: Infection Control
Reason: Infection Control
March 23, 2022
$5,000
Stipulation & Order #NH-22-156 · Signed November 2, 2022
Reason: Quality of Care
Reason: Quality of Care