Lawrence Nursing Care Center, Inc

F-F584 for further information.

2) The facility daily nursing actual staffing schedules from 10/01/2024 to 12/31/2024 revealed consistently low staffing of Certified Nursing Assistants especially on weekends. This includes but not limited to: On 10/06/2024, Sunday, 7 AM to 3 PM shift, there were 4 Certified Nursing Assistants scheduled for each unit (Units 2, 3, 4, 5, and 6) which had census ranges from 35 to 40 residents. The daily staffing documentation revealed 3 Certified Nursing Assistants worked on each unit.

Refer to citation text at

F-F725 for further information

3) The facility did not ensure that safe, sanitary conditions were maintained in the kitchen. Food items were not labeled and dated, freezer temperatures were not observed to be out of acceptable range, and standing water was observed in the dry food storage areas.

Refer to citation text at

F-F812 for further information.

4) The facility did not ensure that there were sufficient emergency provisions for residents, staff and family or volunteers.

Refer to citation text at E0015 for further information.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 23 of 33 335415 Department of Health & Human Services Printed: 09/10/2025 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 335415 B. Wing 01/22/2025

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

Lawrence Nursing Care Center, Inc 350 Beach 54th Street Arverne, NY 11692

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 0835 5) The facility did not ensure effective Quality Assurance and improvement programs to monitor and enhance the quality of care and service and compliance with all federal, state, and local regulations Level of Harm - Minimal harm or governing nursing home operation by repeating citations from the last survey conducted from 12/22/2022 to potential for actual harm 01/05/2023.

Residents Affected - Many Refer to citation text at

F-F880 Infection prevention and Control.

The facility policy and procedure titled Enhanced Barrier Precautions effective 12/10/2024 documented all personnel which have direct contact with a resident with indwelling medical devices, regardless of multidrug-resistant organism colonization or infection status, the facility will implement Enhanced Barrier Precautions. Enhanced Barrier Precautions involve gown and glove use during high contact resident care activities which provide opportunities for transfer of multidrug-resistant organism to staff hands and clothing.

The facility policy titled Hand Hygiene Policy effective 10/28/2024 stated that apply antimicrobial soap or hand hygiene agent and thoroughly distribute over hands and wrist. Use a rotary motion and vigorously rub hands together for 20-40 seconds generating friction on all surfaces of hands and fingers.

Resident #169 was admitted with Diagnoses that included Non-Alzheimer's Dementia, Cancer, and Malnutrition.

The Significant Change in Status Minimum Data Set assessment dated [DATE REDACTED] documented that Resident #169 was severely cognitively impaired and had a feeding tube.

The physician's order dated 12/04/2024 documented tube feeding- continuous using pump kit, IV pole, and pump due to failure to thrive. Formula: Fibersource HN Total Formula Volume: 1800 ml/day Strength Full (90 ml/hr. rate of flow)

A Physician's Order dated 01/08/2025, documented enhanced barrier precautions due to presence of wounds/peg tube/foley.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 25 of 33 335415 Department of Health & Human Services Printed: 09/10/2025 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 335415 B. Wing 01/22/2025

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

Lawrence Nursing Care Center, Inc 350 Beach 54th Street Arverne, NY 11692

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 A sign on the door stated Stop-Enhanced Barrier Precautions: Everyone Must: clean their hands, including

before entering and when leaving the room. The notice also stated that providers and staff must also: wear Level of Harm - Minimal harm or gloves and a gown for the following High-Contact Resident Care Activities, Device care or use: central line, potential for actual harm urinary catheter, feeding tube, tracheostomy.

Residents Affected - Few On 01/16/2025 from 04:01 PM to 04:15 PM, Licensed Practical Nurse #4 was observed performing the administration of enteral feeding to Resident #169 via gastrostomy tube. Licensed Practical Nurse #4 was observed taking a gown into Resident #169's room which they placed on the resident's nightstand. Licensed Practical Nurse #4 then turned on the tap at the sink, adjusted the water, applied soap to their hands and lathered hands and rinsed their hands for approximately ten seconds. Licensed Practical Nurse #4 applied gloves, cleansed Resident #169's peg tube site with gauze moistened with water, flushed the tube, and set

the pump. Licensed Practical Nurse #4 left the resident's room and went to the medication cart where they retrieved several gauze pads and normal saline from the cart. Licensed Practical Nurse #4 re-entered the resident's room, and did not perform hand hygiene or don a gown. Licensed Practical Nurse #4 then donned gloves, cleaned the site with gauze moistened with normal saline, wiped site dry, applied dry dressing and hung feeding. Licensed Practical Nurse #4 discarded the unworn gown and used supplies, removed gloves, and washed hands again for approximately 10 seconds before leaving the resident's room.

On 01/16/2025 at 04:35 PM, Licensed Practical Nurse #4 was interviewed and stated that when washing hands they go to the sink, turn water on, put the soap on and rub with friction for 10 seconds. Licensed Practical Nurse #4 also stated that the whole handwashing process should last for 20 seconds but they do not think that they did if for this long today. Licensed Practical Nurse #4 stated that they were aware there is

a sign on the door for precautions and they think it is for contact precautions which means they should wear gloves and a mask. Licensed Practical Nurse #4 then reviewed the sign on the door and stated that the sign was for Enhanced Barrier Precautions so they should wear you wear gloves and mask. Licensed Practical Nurse #4 then stated that they thought that they were supposed to wear a gown. Licensed Practical Nurse #4 also stated that they were inserviced some time ago, but could not recall when, but remembered that they were told to wear gowns for residents who come in from the hospital with some kind of infection, and that Enhanced Barrier Precautions were to be used for residents who had a bacterial infection or something.

On 01/16/2025 at 04:44 PM, the Assistant Director of Nursing, who is also the Infection Control Preventionist, was interviewed and stated that they informed staff about hand washing, personal protective equipment before they start working their shift and staff were also told during the in-service. The Assistant Director of Nursing also stated that when washing hands, staff should rub hands for 20- 30 seconds. The Assistant Director of Nursing further stated that residents on Enhanced Barrier Precautions have signs on their door to let staff know that they need to wear Personal Protective Equipment which includes gowns and gloves. The Assistant Director of Nursing stated that the Director of Nursing and themselves do education on hand washing and precautions.

10 NYCRR 415.19(b)(4)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 26 of 33 335415 Department of Health & Human Services Printed: 09/10/2025 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 335415 B. Wing 01/22/2025

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

Lawrence Nursing Care Center, Inc 350 Beach 54th Street Arverne, NY 11692

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 0921 Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 19546

Residents Affected - Many Based on observations, record review, and staff interviews during the Recertification and Extended Survey from 01/14/2025 to 01/22/2025, the facility did not ensure that it provided a safe, functional, sanitary, and comfortable environment for residents, staff and the public. This was evidenced by multiple observations of

the outside front entrance, staff bathrooms, elevators and nursing stations.

The findings are:

The facility policy titled Environmental Services dated 03/2024 stated that Housekeeping staff are responsible to keep the environment safe, sanitary, and comfortable, and attractive for our residents, staff, and visitors. The policy also stated that the entire facility, inside and outside of its buildings, as well as surrounding premises including, but not limited to the floors, walls, windows, doors, ceilings, fixtures, equipment, furnishings, walkways, and driveways, shall be maintained in good repair, clean and free of insects, rodents, and trash.

On multiple occasions from 01/14/2025 to 01/22/2025 the following was observed:

1. Front Entrance Pavement:

a. The outside pavement leading to the front door entrance was widely cracked and broken.

2. Lobby Area: Main Dining:

a. Dining room tables were unsteady and in disrepair, exposing inner corking along the edges.

3. Elevators:

a. 2 of 2 elevators had an accumulation of dirt and debris within the tracks.

b. the inside elevator doors and walls had streaks and stains.

c. the floors along the edges were embedded with black-colored substance, dirt, and debris.

4. 2nd floor staff bathroom:

a. there were unidentified odors

b. there were broken wall tiles

c. there was a stained and dirty mirror

e. the paper towel dispenser was dusty

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 27 of 33 335415 Department of Health & Human Services Printed: 09/10/2025 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 335415 B. Wing 01/22/2025

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

Lawrence Nursing Care Center, Inc 350 Beach 54th Street Arverne, NY 11692

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 0921 f. there was embedded dirt and debris along floor edges and corners.

Level of Harm - Minimal harm or g. walls were stained and dirty potential for actual harm 5. 2nd floor Nurse Station: Residents Affected - Many a. the counter top edges were broken and chipped.

b. the wall below the fan area heavily streaked and stained.

c. 2 black swivel chairs and seat cushion were layered with dust and stains. The back of the chairs was with layered dust and dirt.

6. Housekeeping equipment:

a. the outer aspect of the yellow mop bucket used by housekeepers was embedded with black dirt.

7. The 6th floor nurses station

a. the arm rest padding on one of the chairs was torn and had a dark colored discoloration.

8. The 3rd Floor

a. upholstery on the chairs in nursing station was discolored and appeared soiled.

b. the hand sanitizers in the hallway were dusty.

On 01/22/2025 at 10:35 AM, Housekeeper #3 who worked the 7 AM to 3 PM shift and was assigned to the 2nd Floor unit was interviewed and stated that their routine housekeeping duties include but are not limited to routine cleaning and upkeep of the entire 2nd floor unit. Housekeeper #3 also stated that this included dust mopping and mopping the floors of the entire corridor, dining room area, resident rooms, and bathroom floors, wiping and dusting resident rooms and resident furniture including room and bathroom mirrors when dirty.

On 01/22/2025 at 11:26 AM, the Director of Maintenance and currently the Acting Director of Housekeeping Services was interviewed and stated that their primary role is maintaining the major systems in the facility.

The Director of Maintenance also stated that the facility has a challenging population, and they are confronted with leaks due to overflow of toilets which cause havoc on the floors, walls and ceilings. The Director of Maintenance further stated that this is a [AGE] year-old building and given the population, they consistently find themselves patching up problem areas. The Director of Maintenance stated that there is no formulated plan as yet for renovations of the units, but it is in discussion.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 28 of 33 335415 Department of Health & Human Services Printed: 09/10/2025 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 335415 B. Wing 01/22/2025

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

Lawrence Nursing Care Center, Inc 350 Beach 54th Street Arverne, NY 11692

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 0921 On 01/22/2025 at 01:06 PM, the Administrator was interviewed and stated that the facility is an old building with a difficult population. The Administrator also stated that they try to maintain a clean and safe Level of Harm - Minimal harm or environment which is why there is a housekeeper assigned to each unit. The Administrator further stated that potential for actual harm they make daily rounds to ensure the cleanliness and safety requirements are met, and they have gone over their concerns with the staff when issues have been identified. The Administrator stated that is a proposal Residents Affected - Many that was initiated in 2022 to renovate the first-floor lobby area and the Rehabilitation area, but the proposed work has not yet been started.

10 NYCRR 415.29

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 29 of 33 335415 Department of Health & Human Services Printed: 09/10/2025 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 335415 B. Wing 01/22/2025

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

Lawrence Nursing Care Center, Inc 350 Beach 54th Street Arverne, NY 11692

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 0941 Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members. Level of Harm - Minimal harm or potential for actual harm 51587

Residents Affected - Some Based on interview and record review during a Recertification and Extended survey from 01/14/2025 through 01/22/2025, the facility did not ensure an effective training program for all new and existing staff was developed, implemented, and maintained based on the facility assessment. Specifically, for 6 of 6 employee files reviewed, the facility did not include effective communications as a mandatory training for direct care staff.

The findings are:

The facility policy titled Staff training/Development dated 11/16/2024 stated that the facility's staff development process would be directed towards personal and professional growth of its personnel. The policy also stated that Certified Nursing Assistants will receive at least twelve (12) hours of education on an annual basis. Training will include dementia management, effective communications, and abuse prevention training.

On 01/22/25 at 02:45 PM, training plans were reviewed for 6 randomly selected Certified Nurse Assistants as follows:

1.The Orientation In-service Exam and Attestation Booklet for Certified Nurse Assistant #1 dated 09/20/24 did not include training on Effective Communication Techniques as a mandatory training for staff.

2. The Orientation In-service Exam and Attestation Booklet for Certified Nurse Assistant #2 dated 09/03/24 did not include training on Effective Communication Techniques as a mandatory training for staff.

3. The Orientation In-service Exam and Attestation Booklet for Certified Nurse Assistant #3 dated 09/03/24 did not include training on Effective Communication Techniques as a mandatory training for staff.

4. The Orientation In-service Exam and Attestation Booklet for Certified Nurse Assistant #4 dated 09/03/24 did not include training on Effective Communication Techniques as a mandatory training for staff.

5. The Orientation In-service Exam and Attestation Booklet for Certified Nurse Assistant #5 dated 09/03/24 did not include training on Effective Communication Techniques as a mandatory training for staff.

6. The Orientation In-service Exam and Attestation Booklet for Certified Nurse Assistant #6 dated 10/12/24 did not include training on Effective Communication Techniques as a mandatory training for staff.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 30 of 33 335415 Department of Health & Human Services Printed: 09/10/2025 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 335415 B. Wing 01/22/2025

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

Lawrence Nursing Care Center, Inc 350 Beach 54th Street Arverne, NY 11692

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 0941 During an interview on 01/22/25 at 02:35 PM, the Director of Nursing was interviewed and stated they do the in-service training, but they did not provide training on Effective Communication Techniques. The Director of Level of Harm - Minimal harm or Nursing also stated that they would inquire whether the Administrator had provided this training to staff, potential for actual harm however the Director of Nursing did not provide any further updates on this issue.

Residents Affected - Some 10 NYCRR 415.26

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 31 of 33 335415 Department of Health & Human Services Printed: 09/10/2025 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 335415 B. Wing 01/22/2025

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

Lawrence Nursing Care Center, Inc 350 Beach 54th Street Arverne, NY 11692

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 0944 Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program. Level of Harm - Minimal harm or potential for actual harm 51587

Residents Affected - Some Based on interview and record review during a Recertification and Extended survey from 01/14/2025 through 01/22/2025, the facility did not ensure an effective training program for all new and existing staff was developed, implemented, and maintained based on the facility assessment. Specifically, for 6 of 6 employee files reviewed, the facility did not provide mandatory training that outlines and informs staff of the elements and goals of the facility's Quality Assurance Performance Improvement program as part of its Quality Assurance Performance Improvement program.

The findings are:

The facility policy titled Staff training/Development dated 11/16/2024 stated that the facility's staff development process would be directed towards personal and professional growth of its personnel. The policy also stated that Certified Nursing Assistants will receive at least twelve (12) hours of education on an annual basis. Training will include dementia management, effective communications, and abuse prevention training. The policy did not state that training on the Quality Assurance Performance Improvement program would be provided to staff.

On 01/22/25 at 02:45 PM, training plans were reviewed for 6 randomly selected Certified Nurse Assistants as follows:

1.The Orientation In-service Exam and Attestation Booklet for Certified Nurse Assistant #1 dated 09/20/24 did not include training on the Quality Assurance Performance Improvement program.

2. The Orientation In-service Exam and Attestation Booklet for Certified Nurse Assistant #2 dated 09/03/24 did not include training on the Quality Assurance Performance Improvement program.

3. The Orientation In-service Exam and Attestation Booklet for Certified Nurse Assistant #3 dated 09/03/24 did not include training on the Quality Assurance Performance Improvement program.

4. The Orientation In-service Exam and Attestation Booklet for Certified Nurse Assistant #4 dated 09/03/24 did not include training on the Quality Assurance Performance Improvement program.

5. The Orientation In-service Exam and Attestation Booklet for Certified Nurse Assistant #5 dated 09/03/24 did not include training on the Quality Assurance Performance Improvement program.

6. The Orientation In-service Exam and Attestation Booklet for Certified Nurse Assistant #6 dated 10/12/24 did not include training on the Quality Assurance Performance Improvement program.

During an interview on 01/22/25 at 02:35 PM, the Director of Nursing was interviewed and stated they do the in-service training, but they did not provide training the Quality Assurance Performance Improvement program. The Director of Nursing also stated that they would inquire whether the Administrator had provided

this training to staff, however the Director of Nursing did not provide any further updates on this issue.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 32 of 33 335415 Department of Health & Human Services Printed: 09/10/2025 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 335415 B. Wing 01/22/2025

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

Lawrence Nursing Care Center, Inc 350 Beach 54th Street Arverne, NY 11692

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 0944 10 NYCRR 415.26

Level of Harm - Minimal harm or potential for actual harm

Residents Affected - Some

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 33 of 33 335415