HUNTINGTON STATION, NY - Federal health inspectors found that Apex Rehabilitation & Care Center employed five individuals to work as registered nurses for years without proper New York State licenses or permits, while simultaneously documenting critical lapses in infection control and patient monitoring protocols.
Major Staffing Violations Uncovered
The April 2025 inspection revealed that five medication and treatment nurses had been working at the 78 Birchwood Drive facility as registered nurses without valid credentials. Three of these individuals had been employed in nursing roles since 2021, while two others had worked without proper licensing since 2023.
Personnel file reviews showed extensive documentation gaps. None of the five nurses had current New York State registered nurse licenses. Their files contained incomplete or unsigned limited permit applications, with some applications entirely undated. Several nurses held foreign nursing school diplomas but lacked the required New York State authorization to practice.
The facility's Director of Human Resources acknowledged the situation during interviews, stating that efforts to obtain proper credentials from staffing agencies had been unsuccessful. "They were not able to continue to follow up with the employees and the employees' agency to ensure appropriate credentials were obtained because they were busy with numerous other responsibilities at the facility," according to the inspection report.
One unlicensed nurse interviewed by inspectors revealed they had been working under an expired limited permit. When asked about obtaining proper licensure, they stated "they did not start the process of applying for the National Council License Examination for Registered Nurses (NCLEX-RN) examination to become a New York State licensed Registered Nurse because they were too busy."
Understanding Nursing License Requirements
New York State requires all practicing registered nurses to hold either a valid state license or an approved limited permit. Limited permits are temporary authorizations for nursing school graduates who have applied for licensure but have not yet taken or passed the NCLEX-RN examination. These permits are valid for up to one year and require specific supervision arrangements.
The distinction between licensed and unlicensed nursing practice is critical for patient safety. Licensed nurses have completed standardized education, passed competency examinations, and are subject to state oversight and disciplinary actions. Unlicensed individuals practicing nursing violate state law and put patients at risk through potentially inadequate training and lack of professional accountability.
Medication administration represents a particularly high-risk area. Licensed nurses receive extensive training in pharmacology, drug interactions, proper dosing calculations, and adverse reaction recognition. When unlicensed individuals perform these functions, residents face increased risks of medication errors, missed drug interactions, and inadequate monitoring for adverse effects.
Breakdown in Infection Control Protocols
Inspectors documented two significant infection control violations that demonstrated systemic failures in basic safety protocols. The first involved a resident with shingles who had been placed on contact precautions but lacked proper isolation signage after being moved between rooms.
The resident had developed a blistery rash and was diagnosed with shingles, requiring antiviral treatment and contact precautions. While the facility initially placed the resident in a private room for isolation, they later moved the patient back to a shared room without posting required contact precaution signs outside the door.
Contact precautions are essential for preventing disease transmission. Shingles can spread through direct contact with the rash, particularly to individuals who have never had chickenpox or received the varicella vaccine. Proper signage alerts all staff and visitors to use appropriate personal protective equipment, including gloves and gowns, to prevent viral transmission.
The second infection control violation involved improper hand hygiene during blood glucose testing. An unlicensed nurse was observed performing finger stick testing on a diabetic resident without washing hands before putting on gloves or after removing them.
Hand hygiene represents the most fundamental infection prevention measure in healthcare settings. Proper handwashing before and after patient contact prevents cross-contamination between residents and reduces healthcare-associated infection risks. Blood glucose testing involves direct patient contact and potential blood exposure, making hand hygiene particularly critical.
Critical Documentation Failures
Inspectors found that a dialysis patient's medical records lacked proper monitoring documentation for their permanent catheter (Permacath). The resident required regular assessment of the catheter site for bleeding, proper placement, and skin integrity, but nursing staff failed to document these critical safety checks.
Dialysis catheters require vigilant monitoring due to serious complication risks. These devices create direct vascular access, making patients vulnerable to bleeding, infection, and catheter displacement. Regular assessment can identify problems early, preventing life-threatening complications such as hemorrhage or bloodstream infections.
The facility's own policies required catheter monitoring every shift with documentation on treatment administration records. However, medical record reviews showed gaps in weekend monitoring when the resident did not receive dialysis treatments.
During interviews, nursing staff acknowledged performing visual assessments but failing to document their findings. One nurse stated they "assessed the resident's right chest Permacath for any signs of infection, but did not document their assessment in the resident's medical record."
Industry Standards and Best Practices
Healthcare facilities must maintain rigorous credentialing processes to ensure all clinical staff possess appropriate qualifications. Standard practice includes initial license verification, ongoing monitoring of license status, and immediate action when credentials expire or become invalid.
Effective infection control programs require multiple safeguards. These include proper signage for isolation precautions, staff education on protective equipment use, and strict adherence to hand hygiene protocols. Regular auditing and immediate correction of violations help maintain compliance and protect residents.
Medical record documentation serves as both a legal record and communication tool among healthcare providers. Complete documentation ensures continuity of care, enables quality monitoring, and provides evidence of appropriate medical management.
Additional Issues Identified
The inspection report documented several other concerning findings. Nursing supervisors acknowledged awareness of the unlicensed staff situation but failed to take corrective action. The Director of Nursing Services stated they "did not make it their priority to ensure the nurses had appropriate credentials available to work at the facility as Registered Nurses" due to being "busy doing other things."
Administrative oversight also proved inadequate. The facility Administrator acknowledged the violations represented "an oversight on their part" while claiming responsibility lay with human resources staff for maintaining proper credentials.
The facility's policies appeared adequate on paper, requiring license verification and background checks before employment begins. However, implementation failures allowed unlicensed individuals to continue working for years without intervention.
These violations collectively demonstrate systemic breakdowns in fundamental safety protections that nursing home residents depend upon for their health and wellbeing.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Apex Rehabilitation & Care Center from 2025-04-16 including all violations, facility responses, and corrective action plans.
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