Adelphi Nursing And Rehabilitation Center
Inspection Findings
F-Tag F0656
F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Based on interview, record review, and facility policy review, the facility failed to develop a care plan to address how staff should care for and monitor a resident's pacemaker for 1 (Resident #16) of 4 sampled residents reviewed for a pacemaker.Findings included:Review of a facility policy titled Care Planning, effective 11/01/2019, revealed Policy A licensed nurse, in coordination with the interdisciplinary team, develops and implements an individualized care plan for each patient in order to provide effective, person-centered care, and the necessary health-related care and services to attain or maintain the highest practical physical, mental, and psychosocial well-being of the patient.An admission Record indicated the facility admitted Resident #16 on 08/11/2025. According to the admission Record, the resident had a medical history that included diagnoses of atrial fibrillation and heart failure.Continued review of an admission Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 08/16/2025, revealed Resident #16 had a Brief Interview for Mental Status (BIMS) score of 6, which indicated the resident had severe cognitive impairment.Resident #16's Care Plan Report included a focus created 08/19/2025 and revised 09/10/2025 that indicated the resident was at risk for cardiac complications secondary to atrial fibrillation, congestive heart failure, severe tricuspid regurgitation, hypotension, cardiomyopathy, and severe tricuspid regurgitation. According to the Care Plan Report, there was no focus area that specified the resident had a pacemaker or interventions that directed staff how to monitor the resident's pacemaker for proper functioning.Resident #16's Order Summary Report revealed an order dated 10/16/2025, that specified FYI [for your information]: Resident has pacemaker device, every shift.During an interview on 10/16/2025 at 6:01 PM, Resident #16 acknowledged they had a pacemaker. During an interview on 10/20/2025 at 8:54 AM, the Director of Nursing stated Resident #16's pacemaker should be addressed on their care plan.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility ID:
If continuation sheet
Event ID:
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
10/20/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Adelphi Nursing and Rehabilitation Center
1801 Metzerott Road Adelphi, MD 20783
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0684
F 0684 Level of Harm - Minimal harm or potential for actual harm
During an interview on 10/20/2025 at 4:34 PM, the Administrator when Resident #13 fell out of bed on 10/02/2025, GNA #14 got help from Housekeeper #22 to get the resident back in bed. The Administrator stated when an incident happened, the staff must notify the charge nurse.
Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
10/20/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Adelphi Nursing and Rehabilitation Center
1801 Metzerott Road Adelphi, MD 20783
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0842
F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
on the records before they entered (transcribed) the order. During an interview on 10/16/2025 at 8:50 AM,
the Director of Nursing (DON) stated when a resident admitted to the facility from a hospital, she expected
the nursing staff to review the transfer (discharge) summary to ensure the name and medication orders matched. The DON stated the hospital staff mixed up their records and there was a one-time dose of tranexamic acid prescribed to another patient that ended up being transcribed onto Resident #2's MAR because the nurse did not check the name on the paperwork. During a follow-up interview on 10/20/2025 at 9:19 AM, the Administrator stated there was a transcription error that occurred because the name of the resident's paperwork (discharge summary) wasn't checked before the order was transcribed to Resident #2's MAR.
Event ID:
Facility ID:
If continuation sheet
ADELPHI NURSING AND REHABILITATION CENTER in ADELPHI, MD inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in ADELPHI, MD, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from ADELPHI NURSING AND REHABILITATION CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.