Hudson Park Rehabilitation And Nursing Center

F-F657: Care Plan Timing and Revision

The Policy and Procedure titled, Incident Report, Residents and last revised 03/05/2024, documented any bruises, cuts, lacerations, etc. sustained during a fall must have a size and description documented by the nurse and nursing staff should continue to monitor for any changes, injury, or effects of the incident.

Resident #524

Resident #524 admitted to facility with diagnosis which included insomnia, depression and acute respiratory failure. The Minimum Data Set (as assessment tool) dated 5/14/2024 documented the resident could sometimes be understood and could sometimes understand others with cognitive impairment for decisions of daily living.

During an observation on 6/05/2024 at 11:22 AM, Resident #524 was seated in a wheelchair by second floor nurse's station with an uncovered wound on their right shin, which appeared to be approximately 7.62 centimeters long and 1.27 centimeters wide. The wound had thickened, reddened edges without weeping or bleeding.

A Nursing Progress Note dated 5/22/2024, written by Registered Nurse #2, documented Resident #584 had been found on the ground near the nurse's station. Upon assessment, the resident had a lacerated wound noted on their right leg shin area with a measurement of 1.4 centimeters by 0.6 centimeters. A steri strip (thin adhesive bandages that help close shallow cuts or wounds) was applied on the affected area and covered with an optifoam patch (wound dressing). The resident's family and physician were documented to have been notified.

Review of the Treatment Administration Record revealed that Resident #524 had a standing (on-going) physician order with a start date of 4/25/2024 to treat any skin tears as needed by cleansing the wound, covering with an optifoam wound dressing and changing the dressing every three days. Review of the record revealed nursing staff did not sign off that wound care and dressing changes were completed from 5/22/2024 to 6/05/2024.

During an interview on 06/05/2024 at 11:35 AM, Registered Nurse #1 stated that Resident #524 had a recent fall, during which they obtained the injury to their right shin. They stated that the wounds should be cleansed, covered, and dressing changed every three days. They stated Resident #524 had a behavior of picking at their skin and removing wound dressings.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 24 335812 Department of Health & Human Services Printed: 09/23/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 335812 B. Wing 06/12/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Hudson Park Rehabilitation and Nursing Center 325 Northern Boulevard Albany, NY 12204

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 0684 A Registered Nurse assessment dated [DATE REDACTED] at 12:50 PM, written by Registered Nurse #1, documented Resident #524's continued to be unchanged in size and that the resident continued to pull off the dressing Level of Harm - Minimal harm or and picks at the wound. The wound edges were thickened, rolled under and appear irritated by the frequent potential for actual harm picking. The wound was dry with no drainage or odor. Treatment was updated to have wound dressing changed every 3 days, with kerlix (wound dressing) added to deter the resident from removing their dressing Residents Affected - Few and picking the wound.

A Treatment Order was entered for Resident #524 on 06/05/2024 (14 days after the injury was first observed) for the wound to be cleansed and optifoam wound dressing to be applied and secured with kerlix (wound dressing) every three days and as needed.

A Wound assessment dated [DATE REDACTED] at 2:40 PM, completed by Wound Nurse #1, documented the resident was seen for assessment of a skin tear to the resident's right shin. The wound was documented to be 4 centimeters long by 0.9 centimeters wide. The wound was documented with partial thickness. The measurement revealed that the wound had more than doubled in length from when it was first assessed to be 1.4 centimeters long at the time of the fall. The wound was photographed during the assessment.

Review of Resident #524's Care Plan, revealed the care plan was updated on 6/05/2024 (14 days after the injury was first observed) to include that the resident had an actual impairment of skin integrity as evidenced by a skin tear to their right shin. Interventions included nursing staff should follow the facility's skin tear protocol, treatment were to be completed per physician orders and the resident was to be seen on weekly rounds by the Wound Nurse and measurements obtained. An Occupational Therapy/Physical Therapy assessment was to be completed per physician order to evaluate positioning devices and/or therapy needs to promote wound healing.

During an observation on 6/07/2024 at 9:40 AM, Registered Nurse #1 took measurements for Resident #524's wound and reported that the wound was 3.8 centimeters long by 0.8 centimeters wide with a depth of 0.1 centimeters. The wound appeared to be improved from when it was initially observed on 6/05/2024.

A Wound assessment dated [DATE REDACTED] at 8:13 AM completed by Wound Nurse #1, documented the wound was identified on 6/05/2024, however, a note added to the bottom the assessment documented that the assessment was a late entry and was actually completed on 5/29/2024 (12 days prior). The assessment documented the wound was 3 centimeters long by 0.5 centimeters wide. The wound was not photographed

during the assessment, and it was documented that this was due to the resident being restless at the time.

During an interview on 6/11/2024 12:50 PM, Registered Nurse #2 stated they were working on another unit when they were called to come assess Resident #524 on 5/22/2024. They stated the resident was on the floor near the nurse's station and upon assessment, had sustained a wound to their right shin. They stated when they first observed the wound, it appeared to be a laceration (a deep cut or tear of the flesh). They stated they used the side of a piece of gauze to measure the size of the wound and relayed the measurements to the on-call physician. They stated they had not been trained in obtaining wound measurements.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 24 335812 Department of Health & Human Services Printed: 09/23/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 335812 B. Wing 06/12/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Hudson Park Rehabilitation and Nursing Center 325 Northern Boulevard Albany, NY 12204

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 0684 During an interview on 6/11/2024 at 3:10 PM, Wound Nurse #1 stated Resident #524's wound had worsened since they had initially assessed the wound. They stated they were initially informed of the wound on Level of Harm - Minimal harm or 5/29/2024 but that they did not enter the assessment in the system until 6/11/2024. They stated the had seen potential for actual harm the resident again on 6/05/2024 for follow-up and the wound was larger. They stated the resident would pick at their skin/wound. They stated typically when they would initially assess a new wound was when they Residents Affected - Few would update the resident's care plan with interventions. They stated it was important to track and monitor wounds for changes and signs of infection.

During an interview on 6/12/2024 at 10:01 AM, Director of Nursing #1 stated wounds should be documented timely, accurately and tracked for any changes. They stated they believed Wound Nurse #1 was first notified of Resident #524's wound and completed an assessment on 5/29/2024, however, they did not enter their assessment into the system until 6/11/2024. They stated sometimes nursing staff would forget to chart their assessments right away. They stated the facility would enter standing orders for treatment of skin tears. They stated when a new wound was identified, treatment orders should be obtained, the Wound Nurse should be notified, and the resident's care plan should be updated. They stated the Wound Nurse should obtain initial measurements in order to track the wound.

10 New York Codes, Rules, and Regulations 415.12

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 16 of 24 335812 Department of Health & Human Services Printed: 09/23/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 335812 B. Wing 06/12/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Hudson Park Rehabilitation and Nursing Center 325 Northern Boulevard Albany, NY 12204

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 0685 Assist a resident in gaining access to vision and hearing services.

Level of Harm - Minimal harm or 48615 potential for actual harm Based on observation, interview, and record review conducted during a Recertification survey, the facility did Residents Affected - Few not ensure that residents received proper treatment and assistive device to maintain hearing abilities for 1 (Resident #58) of 4 residents reviewed. Specifically, Resident #58 did not receive assistance with replacement of broken hearing aids and did not receive follow up Audiologist (a healthcare professional that manages hearing loss and balance disorders) visits for maintenance of hearing aids as recommended. This is evidenced by:

Resident #58 was admitted with diagnosis of Unspecified osteoarthritis (degeneration of bone causing pain and stiffness), Impacted cerumen (ear wax), bilateral; Chronic obstructive pulmonary disease, unspecified (a condition involving constriction of the airways and difficulty or discomfort in breathing). The Minimum Data Set of 3/28/2024, documented resident was cognitively intact, could be understood, and understand others.

During an observation and interview on 6/04/2024 at 1:50 PM, Resident #58 was noted to be very hard of hearing. Resident #58 requested writer stand within 1 inch of their ear to hold conversation. Resident stated

they were hard of hearing, and they do not have a hearing aid. No other hearing adaptive devices were observed for this resident.

Comprehensive Care Plan Titled Alteration in Sensory Perception dated 12/11/2023 documented resident had a hearing deficit. Both ears, considered deaf. Long Term Goal: Resident would maintain adequate communication daily through next review of 7/28/2024. Intervention include Speak slightly louder and towards left ear. Resident lost hearing aide. Schedule hearing consultant and see if it could be replaced.

During an interview on 6/11/2024 at 12:17 PM, Unit Manager, Registered Nurse #4 sated Resident #58's hearing aid had been broken several times as Resident likes to disassemble their hearing aid. Resident had not had a functioning hearing aid since 12/11/2023. An in-house audiology exam was scheduled for 5/13/2024, although, the visit or consultation was not documented. Unit Manager, Registered Nurse #4 stated they would follow up on audiology consult and obtaining a new hearing aid.

During an interview on 06/11/2024 at 12:15 PM, Certified Nurse Aide #5 stated Resident #58 was extremely hard of hearing. They stated they do not attempt to assist Resident #58 because Resident #58 refuses care and yelled at staff a lot.

During an interview on 06/11/2024 at 12:55 PM, Director of Nursing #1 stated residents were followed up every six months for audiology maintenance and as needed.

Review of Treatment Administration Record dated 12/11/2023, documented appointment for audiology hearing aids as needed. There was no documented audiology or hearing consults for Resident #58 after order date.

10 New York Codes, Rules, and Regulations: 415.12(3)(b)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 17 of 24 335812 Department of Health & Human Services Printed: 09/23/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 335812 B. Wing 06/12/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Hudson Park Rehabilitation and Nursing Center 325 Northern Boulevard Albany, NY 12204

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 0695 Provide safe and appropriate respiratory care for a resident when needed.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 47140 potential for actual harm Based on observations, record review, and interviews during the Recertification Survey, the facility did not Residents Affected - Few ensure that residents who required respiratory care were provided such care in a manner consistent with professional standards of practice, the comprehensive person-centered care plan, and the resident goals and preferences for 2 (Resident #20 and 98) of 3 residents reviewed. Specifically, Resident #s 20 and 98 oxygen therapy were not administered as ordered by the physician.

This is evidenced by:

The Policy and Procedure titled Oxygen Administration, last revised on 4/09/2024, documented the purpose of the procedure was to provide guidelines for safe oxygen administration. The procedure included that nursing staff should first verify the physician order for oxygen and then adjust the flow of oxygen as prescribed.

Resident #20

Resident # 20 was admitted with diagnoses of Parkinson ' s Disease (disorder that affects the nervous system and the parts of the body controlled by the nerves); diabetes mellitus (a disease in which the body does not control the amount of glucose (a type of sugar) in the blood). chronic obstructive pulmonary disease (a lung disease causing restricted airflow and breathing problems). The Minimum Data Set (an assessment tool) dated 3/29/2024, documented resident was cognitively intact, could be understood and could understand others.

During an observation and interview on 6/04/24 at 11:28 AM, Resident #20 was noted to have oxygen via nasal canula set at 3 liters per minute. Resident #20 stated they recently had pneumonia and asked for oxygen. They were given oxygen and since then applied oxygen as needed.

Nursing Progress Note dated 4/16/2024, documented Chest X-ray result taken on 4/15/2024, showed left basilar pneumonia or effusion, was relayed to Nurse Practitioner #1. Ordered to start Azithromycin 500milligram tablet today, then 250 milligram tablets tomorrow until 4/21/24.

Comprehensive Care Plan Titled Alteration in Respiratory status requiring oxygen, dated 7/17/2023, last revised 1/23/2024, Intervention include obtain and document oxygen saturation as per physician orders.

The Medication and Treatment Administration Reports dated 3/20/2023 - 5/23/2024 had no orders for oxygen therapy.

48615

Resident #98

Resident #98 was admitted to facility with diagnoses which included chronic obstructive pulmonary disease, acute pulmonary edema and glaucoma. The Minimum Data Set, dated dated dated [DATE REDACTED] documented the resident was cognitively intact, could be understood and could understand others.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 18 of 24 335812 Department of Health & Human Services Printed: 09/23/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 335812 B. Wing 06/12/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Hudson Park Rehabilitation and Nursing Center 325 Northern Boulevard Albany, NY 12204

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 0695 Comprehensive Care Plan, Titled at Risk for Compromised Respiratory status dated 4/04/2024, documented

the resident was at risk for compromised respiratory status related to diagnoses of chronic obstructive Level of Harm - Minimal harm or pulmonary disease, pulmonary edema and recent intubation. Interventions included resident to receive potential for actual harm oxygen therapy as ordered at a flow rate of 4 liter per minute.

Residents Affected - Few A Physician Order dated 4/02/2024 documented 4 liters per minute of continuous oxygen flow.

During an observation on 6/04/24 at 12:29 PM, Resident #98 was seated in the dining room on the second floor. The resident had oxygen via nasal cannula with a portable oxygen contractor which was set to a liter flow of 2 liters per minute.

During an observation and interview on 6/05/24 at 9:13 AM Resident #98 was lying in their bed receiving oxygen therapy via nasal cannula with the concentrator set to a liter flow of 3 liters per minute.

During an interview on 6/07/2024 at 11:52 AM, Licensed Practical Nurse #2 stated only nurses could adjust

the liter flow on oxygen concentrators. They stated that all residents who required oxygen therapy should have a physician order which indicated how much oxygen the resident should be administered, how it should be delivered (nasal cannula versus face mask) and how often (continuously or as needed). They stated that oxygen therapy was considered to be the same as administering a medication and should always be administered as indicated by the physician order. They stated that if a resident did not receive enough oxygen, they could potentially have increased confusion or become lightheaded.

During an interview on 6/11/2024 at approximately 2:00 PM, Registered Nurse #1 stated that the adjustment of liter flow on an oxygen concentrator needed to be completed by a nurse. They stated that each resident that required supplemental oxygen should have a physician order which indicated a prescribed liter flow per minute. They stated that some risks existed for residents who received too much or too little oxygen.

During an interview on 6/12/2024 at 10:01 AM, Director of Nursing #1 stated that all residents who required oxygen therapy should have physician order which indicated the amount of oxygen the resident required to maintain oxygen levels. They stated that nurses should check the physician order to ensure that oxygen was administered correctly. They stated that some residents had physician orders to titrate (determine and adjust

the needed concentration) of oxygen when within certain parameters of oxygen saturation. Director of Nursing #1 reviewed Resident #98 ' s physician orders and noted that Resident #98 did not have an order to titrate oxygen.

10 New York Codes, Rules, and Regulations 415.12 (k)(6)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 19 of 24 335812 Department of Health & Human Services Printed: 09/23/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 335812 B. Wing 06/12/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Hudson Park Rehabilitation and Nursing Center 325 Northern Boulevard Albany, NY 12204

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 0812 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food

in accordance with professional standards. Level of Harm - Minimal harm or potential for actual harm 21414

Residents Affected - Some Based on observation, record review, and staff interview during a Recertification Survey, the facility did not store, prepare, distribute, and serve food in accordance with professional standards for food service safety in

the main kitchen and 4 of 4 kitchenettes. Specifically, the automatic dishwashing machine was not functioning properly, and areas of the main kitchen and unit kitchenettes were not clean.

This is evidenced by:

During observations of the main kitchen on 6/04/2024 at 9:06 AM, the following were observed:

Food contact equipment was being washed in the automatic dishwashing machine and the final rinse temperature was 150 degrees Fahrenheit; the information plate on the dishwashing machine stated that the final rinse is to be 180 degrees Fahrenheit.

The can opener holders, knife rack, kitchen floor in corners and along the wall, dry storage area wall behind

the air handler and floor, locker room floor, and mop buckets were soiled with food particles, dirt, or grime.

During observations on 6/04/2024 at 9:52 AM, the following were observed:

The refrigerator, microwave oven, and cabinets in the second-floor kitchenette were soiled with food spills or food particles.

The refrigerator, microwave oven, and drawers in the third-floor kitchenette were soiled with food spills or food particles.

The refrigerator, drawers, and sink in the fourth-floor kitchenette were soiled with food particles or a black build-up.

The drawers, freezer door gasket, and waste receptacle in the fifth-floor kitchenette were soiled with food particles or grime.

The undated document titled Dishwasher Procedure documented that dietary staff were trained to monitor

the automatic dishwashing machine final rinse temperature for 180 degrees Fahrenheit.

During an interview on 6/04/2024 at 10:05 AM, Interim Food Service Director #1 stated that they would contact the maintenance department to have the dishwashing machine checked, and the can opener holders, knife rack, floors, and items found in the kitchenettes would be cleaned.

During an interview on 6/07/2024 at 12:54 PM, Regional Food Service Director #1 stated that the booster heater servicing the dishwashing machine required a minor repair and was now functioning properly.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 20 of 24 335812 Department of Health & Human Services Printed: 09/23/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 335812 B. Wing 06/12/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Hudson Park Rehabilitation and Nursing Center 325 Northern Boulevard Albany, NY 12204

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 0812 During an interview on 6/07/2024 at 12:56 PM, Administrator #1 stated that a log would be created to ensure

the main kitchen and kitchenettes were kept clean, and kitchen staff would receive education on how to Level of Harm - Minimal harm or check the dishwashing machine for proper functioning and sanitizing. potential for actual harm 10 New York Codes, Rules, and Regulations 415.14(h) Residents Affected - Some Chapter 1 State Sanitary Code Subpart 14

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 21 of 24 335812 Department of Health & Human Services Printed: 09/23/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 335812 B. Wing 06/12/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Hudson Park Rehabilitation and Nursing Center 325 Northern Boulevard Albany, NY 12204

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 0880 Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or 48615 potential for actual harm Based on observations, record review, and interviews during a Recertification Survey, the facility did not Residents Affected - Some maintain an infection control program designed to provide a safe, sanitary, and comfortable environment to help prevent the possible development and transmission of communicable infections for 2 of 4 care units. Specifically, the facility did not ensure staff appropriately used and discarded personal protective equipment.

This is evidenced by:

The Policy and Procedure titled, Infection Prevention and Control Policy last reviewed 5/2024, documented,

An Infection Control Program is established and maintained to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable disease and infections. Important facets of infection prevention include educating staff and ensuring they adhere to proper technique and procedures.

The Policy and Procedure titled, Personal Protective Equipment last revised 3/15/2023, documented, Training in the proper donning, use, and disposal od personal protective equipment is provided upon orientation and at regular intervals.

According to the Centers for Disease Control and Prevention's Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings, last reviewed found online at https://www.cdc. gov/infectioncontrol/guidelines/core-practices/index.html, core practices should include development of processes to ensure that all healthcare personnel understood and were competent to adhere to infection prevention requirements as they performed their roles and responsibilities. Healthcare personnel were required to perform hand hygiene in accordance with Centers for Disease Control and Prevention recommendations. Staff should use an alcohol-based hand rub or wash with soap and water for the following clinical indications: Immediately before touching a patient, before performing an aseptic task (e.g., placing an indwelling device) or handling invasive medical devices, before moving from work on a soiled body site to a clean body site on the same patient, after touching a patient or the patient's immediate environment, after contact with blood, body fluids or contaminated surfaces and immediately after glove removal. Personal protective equipment should be removed and discarded upon completing a task before leaving the patient's room or care area. Healthcare personnel should not use the same gown or pair of gloves for care of more than one patient and disposable gloves should be removed and discarded upon completion of a task or when soiled during the process of care. Healthcare facility was to ensure that healthcare personnel have immediate access to and were trained and able to select, put on, remove, and dispose of personal protective

in a manner that protects themselves, the patient, and others.

During an observation on 6/04/2024 at 11:35 AM, a Resident Assistant walked out of a resident's room on Unit 2 (Resident ' s room was identified by signage as being under Enhanced Barrier Precautions) wearing blue gloves, touched a clean linen cart in the hallway, walked down the hall and into two other resident rooms, went to another clean linen cart at the other end of the hallway, and back into the original resident ' s room with the gloves still on.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 22 of 24 335812 Department of Health & Human Services Printed: 09/23/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 335812 B. Wing 06/12/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Hudson Park Rehabilitation and Nursing Center 325 Northern Boulevard Albany, NY 12204

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 0880 During an observation on 6/04/2024 at 11:43 AM, a Resident Assistant walked up from a resident's room to

the nursing station on Unit 2 and removed blue gloves but did not wash hands or use hand sanitizer. Level of Harm - Minimal harm or potential for actual harm During an observation on 6/04/2024 at 1:00 PM, in a resident's room on Unit 2 (identified by signage as being under Enhanced Barrier Precautions), there were three used surgical gloves balled up on a small Residents Affected - Some dresser in the room.

During an observation and interview on 6/06/2024 10:27 AM, soiled gloves and a plastic bag were on the floor in a resident ' s room on Unit 5. Certified Nurse Aide #3 stated they left bag and gloves on floor because there are no bins for waste. Certified Nurse Aide #3 was later observed exiting the room with the plastic bags filled with soiled contents, brought them to dirty room, and did not wash or sanitize hands after handling the soiled bags.

During an observation and interview on 6/06/2024 10:37 AM, Certified Nurse Aide #4 exited a resident ' s room on Unit 5 with two plastic bags of soiled contents, entered and exited dirty utility room without washing or sanitizing hands, then entered another resident's room that was identified by signage as being under Contact Precautions). Certified Nurse's Aide #4 did not don (put on) protective gown or gloves prior to entering the room. Certified Nurse Aide #4 stated the room was under contact precautions, and that they went into the room to assist, and should have gowned up.

10 New York Codes, Rules, and Regulations 415.19 (a) (1-3)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 23 of 24 335812 Department of Health & Human Services Printed: 09/23/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 335812 B. Wing 06/12/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Hudson Park Rehabilitation and Nursing Center 325 Northern Boulevard Albany, NY 12204

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 0924 Put firmly secured handrails on each side of hallways.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 21414 potential for actual harm Based on observation and interviews during a Recertification Survey, handrails were not maintained on 2 of Residents Affected - Some 4 resident units. Specifically, handrails were not firmly secured and affixed to the corridor walls.

This is evidenced by:

During observations on 6/11/2024 from 9:33 AM through 10:33 AM, handrails were loose and not securely attached to the wall on the second-floor east corridor, fourth floor east corridor, and outside room [ROOM NUMBER]; additionally, the handrail end turn piece was missing from the handrail by room [ROOM NUMBER].

During an interview on 6/11/2024 at 10:30 AM, Director of Maintenance #1 stated that they would assign a maintenance worker to check and secure all handrails and install the turn piece.

During an interview on 6/11/2024 at 2:44 PM, Administrator #1 stated the facility would audit the entire building and securely attach any loose handrails.

10 New York Codes, Rules, and Regulations 713-1.8(a)

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