The resident had a gastrostomy tube surgically inserted into her stomach for liquid nutrition and medications.
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Federal inspectors observed the infection control violation during a November morning medication pass at Five Points at Lake Highlands Nursing and Rehab.
Federal inspectors found the facility failed to maintain basic repairs across three of four resident hallways during a November complaint investigation.
The resident also had epilepsy and moderate cognitive impairment, and would reject care from staff.
The facility ran completely out of the supplement from October 24 through October 27, leaving both residents without their prescribed nutrition.
Stage 4 pressure ulcers represent the most severe category of bedsores, extending through skin and fat into underlying muscle.
The resident has Alzheimer's disease and severe cognitive impairment.
Blood sugar levels above 500 mg/dL constitute a medical emergency.
Federal inspectors found multiple violations in the care of Resident #3 at Elderwood at Cheektowaga during a November 5 complaint investigation.
Garden View Care Center had developed detailed procedures five years earlier for evaluating whether residents could consent to sexual activity.
The resident's clinical record showed diagnoses of nicotine dependence and major depressive disorder.
The incident involved a resident with Alzheimer's disease and a seizure disorder who was completely dependent on staff for all daily care activities.