The Grand Rehabilitation And Nrsg At Guilderland
THE GRAND REHABILITATION AND NRSG AT GUILDERLAND in ALTAMONT, NY — inspection on March 7, 2025.
Found 8 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
F-F554: Resident Self-Administer Medications - Clinically Appropriate
Cross-referenced to
During an observation on 2/24/2025 at 11:30 AM, Resident #14's bed clothes had not been changed effectively and when the sheets were removed the mattress was covered with dead skin.
Resident #20
Resident #20 was admitted to the facility with the diagnoses of schizoaffective disorder (mental health condition that combines symptoms of schizophrenia with mood disorders such as depression), chronic obstructive pulmonary disease, and generalized anxiety order (excessive, frequent, and unrealistic worry about everyday things).
The Minimum Data Set, dated dated [DATE], documented the resident was usually able to understand others, usually able to be understood, and was cognitively intact.
Resident #20's comprehensive care plan for being at risk of being a victim due to inability to understand their surroundings related to dependence on others for activities of daily living, documented interventions to assess the resident for signs and symptoms of abuse and/or neglect and provide assistance with activities of daily living as needed.
During an observation on 2/24/2025 at 9:30 AM, Resident #20 showed surveyor that their toenails were so long they wrapped around the resident's toes and the resident had blisters on multiple toes.
335540
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 335540 B.
Wing 03/07/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
The Grand Rehabilitation and Nrsg at Guilderland 428 State Route 146 Altamont, NY 12009
F-F656: Develop/Implement Comprehensive Care Plan
Cross-referenced to
During an interview on 3/2/2025 at 2:00 PM, Administrator #1 stated they have reached out to providers to help to determine and resolve issues.
They would expect that staff would call the pharmacy for missing doses and to find out when they could be delivered.
They would expect that staff would call the Medical Director to see if something else could be given.
They would expect staff to monitor the resident and document directions given by the provider.
Administrator #1 stated the medication issues in the building just came to light over the last week during survey.
They stated there were medication error/missed dose sheets, but the Administrator had not received any in January or February 2025.
Administrator #1 stated they would expect the nurses to write a progress note about the missed doses that would be included on the 24-hour report that was reviewed daily.
Administrator #1 stated that they had never heard there were not enough staff to get medications administered or resident care done.
During an interview on 3/02/2025 at 3:11 PM, Administrator #1 stated they started house- wide education regarding what was available in the Pyxis and what to do when medications were not available.
Supervisors and unit managers were reeducated on the policy of checking their reports and checking the clinical dashboard for late and/or missing medications.
Daily reports would be run regarding medication errors and missed doses and to if the providers were notified.
Administrator stated they would be checking reports for yellow and red colors (indicated late or missed doses) daily and would try to correct inconsistencies in real time.
335540
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 335540 B.
Wing 03/07/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
The Grand Rehabilitation and Nrsg at Guilderland 428 State Route 146 Altamont, NY 12009
During an interview on 3/06/2025 at 2:37 PM, Licensed Practical Nurse #8 stated if a resident refused a treatment, they would write a note and would notify the manager or charge nurse and call the provider if needed.
They stated wound treatment orders were documented on the treatment administration record and there should not be blanks on the treatment record, which indicated it was not done.
They stated wound care should be done per the physician order.
Licensed Practical Nurse #8 was aware that Resident #115 was ordered to have wound care treatments.
During an interview on 3/07/2025 at 3:08 PM, Registered Nurse Regional Clinical Director #1 stated if the nurse did not have enough time to complete a treatment during their shift, they should notify the provider and provide a hand off to the next shift.
10 New York Codes Rules and Regulations 415.12(c)(1)
335540
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 335540 B.
Wing 03/07/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
The Grand Rehabilitation and Nrsg at Guilderland 428 State Route 146 Altamont, NY 12009
F-F711: Physician Visits - Review Care/Notes/Order
Cross-referenced to:
F-F760: Residents are Free of Significant Medication Errors
Cross-referenced to
The surveyor asked about the rash that was observed on the resident's face
handed the surveyor a tube of cream that was in a clear plastic bag with a pharmacy label on it.
The facility pharmacy label documented Clotrim/Beta cream 1-0-0.5 % generic for Lotrisone.
Apply to per directions topically every day shift for 14 days.
Apply under the breast. Resident #23 stated the nurse left it for them (the resident) to apply themselves.
The resident stated they had applied it to the rash on their face as instructed by the nurse.
The surveyor told the resident that the directions on the cream stated to apply it under the breast.
The resident was not aware it was for the breast and stated they had applied the cream once yesterday afternoon to their face and the rash was gone.
There was a red label on the prescription bag that read, for external use only: keep out of the eyes, inside of nose or mouth. Resident #23 stated they read the label and thought it said apply to affected area only.
They stated they were normally good at reading labels but do not always wear their glasses.
They reported they had no formal assessment to self-administer the medication.
During an interview on 2/26/2025 at 3:48 PM, Physician #1 stated they saw Resident #23 on 2/04/2025 because of a rash on their face, nose, and forehead.
Lotrisone cream was prescribed for the resident's face.
They stated the rash would come and go because the resident was not following proper hygiene.
When they saw the resident, they told the resident the plan was for the resident to shower every day and for the Lotrisone cream to be applied to the face on the affected skin.
They stated the order for the Lortisone had detailed instructions on where the nurse should apply it.
Physician #1 stated they would not expect the patient to use it themselves.
They stated, the instructions were for the nurse, not the patient.
They stated they were not aware the resident had a fungal infection under their breast and could not explain why the prescription from the pharmacy documented to apply under the breast.
The resident only complained about the rash on their face when they saw them on 2/04/2025.
Physician #1 stated a fungal infection on the forehead could spread to the rest of the body.
Resident #77
Resident #77 was admitted to the facility with diagnoses of chronic kidney disease (a long-term condition where the kidneys gradually lose their ability to filter waste products and excess fluid from the blood), cerebral infarction (stroke), and chronic obstructive pulmonary disease.
The Minimum Data Set, dated dated dated [DATE], documented the resident was cognitively intact.
The resident made themselves understood and was able to understand others.
Laboratory Results Report for a basic metabolic profile collected on 12/12/2024 and reported on 12/13/2024 at 2:36 AM, documented critical/abnormal test list: Glucose, B-type natriuretic peptide, Creatinine, Chloride, Calcium, Calculated Osmolality, and estimated Glomerular Filtration Rate.
Physician Progress Note dated 12/13/2024 at 9:10 PM by Nurse Practitioner #4, documented they were notified by the facility to review laboratory results.
Labs collected on 12/12/2024 had notable results for the resident's kidney function and the plan was for a repeat basic metabolic profile laboratory test to be done on 12/16/2024.
335540
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 335540 B.
Wing 03/07/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
The Grand Rehabilitation and Nrsg at Guilderland 428 State Route 146 Altamont, NY 12009