Beechtree Rehab: Infection Control Failures Found - NY
Two residents, identified in the inspection report as Resident 8 and Resident 111, were on contact precautions at the time. Signs posted outside their doors specified exactly what protective equipment staff were required to wear before entering. Staff walked in anyway, without it.
When inspectors interviewed the staff members involved, they said they knew they were supposed to wear a gown and gloves when a resident was on contact precautions. They could not explain why. They did not remember whether they had received any training on isolation procedures when they were hired.
That gap matters. Contact precautions exist for one reason: to keep an active infection from moving from one resident to another. A gown and gloves are the barrier between a contagious organism and the next room down the hall.
The Assistant Director of Nursing told inspectors on August 28 that staff had multiple ways to know a resident was on contact isolation. There was the sign on the door. There was a doctor's order. The information was in the Kardex and the Care Plan. The sign alone listed what protective equipment was required to enter. The system, in other words, was not broken. Staff simply did not follow it.
The Director of Nursing, who also serves as the facility's Infection Preventionist, confirmed to inspectors that contact isolation is ordered when a resident has an active infection, triggered after culture results come back. She said the expectation was clear: anyone entering a contact isolation room was required to wash their hands and put on a gown and gloves before crossing the threshold. The reason, she said, was to decrease the spread of infection.
Her staff knew the rule. They did not know the reason behind it. And on the day inspectors observed them, they did not follow it.
The violation was cited under F0880, the federal infection prevention and control standard, and tagged at a level of minimal harm or potential for actual harm, affecting a few residents. That language is regulatory shorthand. What it describes is staff moving in and out of rooms where residents had active infections, without the equipment designed to keep those infections contained, while other residents lived down the same hallway.
Beechtree's own leadership described a training structure that should have prevented this. Orientation includes infection control education. Annual training reinforces it. The signs on the doors are explicit. None of it stopped what inspectors documented.
The staff members who entered those rooms without protective equipment told inspectors they had also been in other residents' rooms. They did not say whether they had washed their hands between rooms. The inspection report does not say either.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Beechtree Center For Rehabilitation and Nursing from 2025-08-29 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: September 27, 2026 · Our methodology
Beechtree Center For Rehabilitation And Nursing in ITHACA, NY was cited for violations during a health inspection on August 29, 2025.
Two residents, identified in the inspection report as Resident 8 and Resident 111, were on contact precautions at the time.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.