Putnam Ridge

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, interview, and record review during the recertification and abbreviated surveys (#2582376) the facility did not ensure resident choice related to provider of health care services was met for one (1) of one (1) resident investigated for choices. Specifically, Certified Nurse Aide #23 continued to provide care for Resident #75 after their representative communicated a preference of not having Certified Nurse Aide #23 provide care to Resident #75.The findings include:Resident #75 had diagnoses that included but were not limited to dementia, anxiety, and major depressive disorder. The grievance dated 07/11/2025 documented a request was made on 12/14/2024 that Certified Nurse Aide #23 not be assigned to care for Resident #75.

On 01/12/2025, Certified Nurse Aide #23 was observed by Resident #75's son providing cares to Resident #75.The Significant Change Minimum Data Set, dated [DATE REDACTED] documented Resident #75 had severely impaired cognition, no behaviors, and was dependent on staff assistance for all activities of daily living.During an interview on 09/29/2025 at 10:43 AM, the Director of Social Work stated Resident #75's son communicated that they did not want Certified Nurse Aide #23 providing cares to their mother on 12/14/2024. They stated residents and their representatives had the right to determine who provided them with care. They stated they were not certain why Certified Nurse Aide #23 provided care to Resident #75 on 01/12/2025. During an interview on 09/29/2025 at 11:12 AM, the Assistant Director of Nursing stated the unit manager would know how the certified nurse aide was made aware that they should not provide cares to Resident #75. They stated Certified Nurse Aide #23 should not have been assigned to, or provided cares to, Resident #75 on 01/12/2025. During an interview on 09/29/2025 at 11:54 AM, Registered Nurse Unit Manager #11 stated Resident #75's son requested that Certified Nurse Aide #23 not care for their mother.

They stated when communicated to them, they informed the Director of Nursing, Staffing Coordinator, the floor nurses, and Certified Nurse Aide #23. They stated Certified Nurse Aide #23 should not have provided care for Resident #75 on 01/12/2025 since the request was made on 12/14/2024. They stated they were not working on 01/12/2025 and were unaware why Certified Nurse Aide #23 took the assignment. 10NYCRR 415.5(b) (1-3)

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

09/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Putnam Ridge

46 MT Ebo Road North Brewster, NY 10509

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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Based on observation, interview, and record review conducted during the recertification and abbreviated surveys (#2601270), the facility did not ensure all alleged violations of abuse were reported immediately, but not later than 2 hours to the state survey agency for one (1) of two (2) residents reviewed for abuse (Resident #164). Specifically, on the morning of 08/26/2025 Resident #164 was observed with a bruise to

the right eye and bruise to the right arm that was not reported to the state agency until 08/26/2025 at 11:05 PM. The findings include:The policy and procedure titled Abuse Prevention and Reporting dated 01/09/2001, last revised 09/2024 documented if the events that cause the reasonable suspicion (but no later than 2 hours after forming suspicion). Resident #164 had diagnoses including Cerebral Infarction, Pulmonary Embolism, and an unspecified intellectual Disability.The Quarterly Minimum Data Set (A resident assessment tool) dated 06/20/2025 documented the resident had severe cognitive impairment.

And was dependent with all activities of daily living. The Accident and Incident Report dated 08/26/2025 at 11:00 AM documented discoloration to the right eye, Nurse Practitioner notified. Interventions ice and x-rays.The Nurse Practitioner progress note dated 08/26/2025 (late entry) at 1:11 PM documented right forehead ecchymosis, swelling to the right orbit. Assessment and Plan status Post Fall- sent to emergency room for evaluation.The incident Report documented it had not been submitted until 8/26/2025 at 11:05 PM

The reportable incident written by the Director of Nursing on 09/01/2025 summarized on 8/26/25 at 10:30 AM Licensed Practical Nurse #10 entered Resident #164's room and noted bruising to the right eye and notified Licensed Practical Nurse # 8, who assumed the resident had accidently hit the side of her face on

the side rail and intervened by padding the siderail, called the Nurse Practitioner and initiated an Accident and Incident Report. On 8/26/25 at 11:07 AM the Nurse Practitioner assessed the resident and noted increased swelling around the eye and a bruise on the right arm and subsequently concluded the resident's injuries were consistent with a fall. The Assistant Director of Nursing was made aware and began an investigation. During an interview on 09/29/2025 at 11:30 AM the Director of Nursing stated they came to

the building after a concern regarding injuries sustained by Resident #164. They stated an investigation started prior to their arrival at the facility and statements were being taken. They stated after Certified Nurse Aide #7 provided a statement on 08/26/2025 at 11:00PM that they provided care alone, a report was called to the Health Department on 08/26/2025 at 11:05PM. They Stated the bruises as identified by the Nurse Practitioner could be considered injuries of unknown origin. They stated they knew injuries of unknown origin should be reported to the Health Department with in two (2) hours.During an interview on 09/29/2025 at 12:19 PM the Administrator stated they were aware of the event of 08/26/2025 but were not involved in

the investigation. They stated all injuries of unknown origin should be reported to the Health Department within 2 hours. During an interview on 09/29/2025 at 12:53 PM the Assistant Director of Nursing stated they recalled the event of 8/26/25. They stated they evaluated the resident after the Nurse Practitioner assessed

the resident. They stated they started an investigation into how the injury of unknown origin may have occurred and notified the Director of Nursing and the Administrator around 2 PM. They stated they were unaware of when the incident was reported to the Health Department. 10 NYCRR 415.4(b)(2)

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

09/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Putnam Ridge

46 MT Ebo Road North Brewster, NY 10509

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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

During an interview on 09/25/2025 at 4:36 PM Occupational Therapist #21 stated Resident #41 should have rolled gauze in both hands for contractures and the abductor roll between legs. They stated nursing should enter the recommendations made by therapy into the care plans.

During an interview on 09/29/2025 at 12:58 PM Registered Nurse Unit Manager #11 stated the treatment administration record included the directive for application of the gauze rolls by the medication nurse. Upon

review of the care plan Registered Nurse Unit Manager #11 stated they could not locate the documentation

in the care plan to address the use of the gauze rolls or the knee abductor. They stated the care plan must not have gotten transferred over from the previous electronic medical record to the current medical record. 10 NYCRR415.11(c)(1)

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

09/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Putnam Ridge

46 MT Ebo Road North Brewster, NY 10509

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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

would have to transfer them to another chair to attend and would return. Resident #7 waited in the common area, resting in an enclosed frame walker with their eyes closed. At 11:01AM, Resident #7 was still sitting in

the unit common area in an enclosed frame walker. At 11:16AM, Resident #7 remained on the unit in an enclosed frame walker. During an interview on 09/29/2025 12:41 PM, Registered Nurse Unit Manager #11 stated Resident #7 may attend activities off the unit, but they go off the unit in a transport chair. They stated recreation handles transport when taking the residents off the unit. During an interview on 09/29/2025 at 2:46 PM, the Director of Recreation stated Resident #7 was not at the coffee social on 09/25/2025 but does attend off unit activities on occasion. They stated since the introduction of the enclosed frame walker, Resident #7's attendance at off unit activities had decreased. They stated activities staff could not transfer residents from walkers to wheelchairs. They stated nursing staff must assist, and if they nursing staff were busy, it could be difficult finding assistance. 10NYCRR 415.12

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

09/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Putnam Ridge

46 MT Ebo Road North Brewster, NY 10509

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 0689 Level of Harm - Actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

#116 was found in the hall next to the handrail on the floor in front of their wheelchair. The resident was assessed and had no injuries. During an observation on 09/25/2025 from 10:15 AM to 10:45 AM, Resident #116 was unsupervised in the day room. Resident #116 was sliding forward while sleeping in a wheelchair.

The wheelchair had a chair alarm. No staff were supervising the day room. All Certified Nurse Aides were providing morning care, and two (2) Licensed Practical Nurses were passing medications. During an

interview on 09/25/2025 at 10:28 AM, Licensed Practical Nurse #5 stated since there was no unit manager,

the medication nurse was responsible for checking the one (1) hour safety rounds book at the end of each shift to ensure it was complete. They stated the unit clerk usually supervised the day room but was out of

the building. They stated they were unsure which staff should be supervising the day room. They stated

they were aware Resident #116 was at risk for falls and tried to ensure supervision. During an interview on 09/25/2025 at 10:40 AM, Licensed Practical Nurse #3 stated Resident #116 was at high risk for falls and should have every one (1) hour safety checks. They stated they were aware the hourly checks were not being signed consistently. They stated residents in the day room should be supervised by staff, especially residents that were at high risk for falls. During an interview on 09/25/2025 at 10:43 AM, Certified Nurse Aide #4 stated they did the one (1) hour safety checks and were educated to sign the one (1) hour safety check book but never signed it. They stated the unit assistant usually observed the dayroom, but no staff were assigned to supervise the dayroom in their absence. During an interview on 09/25/2025 at 11:46 AM,

the Director of Nursing stated after a 07/03/2025 fall, Resident #116 was placed on one (1) hour safety checks. They stated they were aware Resident # 116 was at high risk for falls. The Director of Nursing stated Resident #116 had a fall on 08/27/2025 but they were unaware the one (1) hour safety check log was incomplete on 08/27/2025 during the 3:00 PM to 11:00 PM shift, therefore they had not followed up with the assigned certified nurse aide. 10NYCRR 415.12(h)(2)

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

09/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Putnam Ridge

46 MT Ebo Road North Brewster, NY 10509

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 0741 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

independently. No staff supervision or redirection was observed. During an observation on 09/26/2025 starting at 08:30AM, Resident #20 was observed in their room eating breakfast independently. Their tray was collected at 08:50AM. Resident #20 wandered in their room and then left the room and was in the hallway, heading toward room [ROOM NUMBER]. Resident #20's pants were visibly soiled, their brief was bulging and appeared low, and their sweatshirt was on backwards. At 9:29 AM Certified Nurse Aide # was coming out of another room and directed Resident #20 back to their room and left. Resident #20 came out of their room again and was entering room [ROOM NUMBER]. Certified Nurse Aide # in the hallway saw Resident #20 and escorted them out of room [ROOM NUMBER] and back to their room for cares at 9:34 AM. During an interview on 09/26/2025 at 10:32 AM, Certified Nurse Aide #12 stated that Resident #20 does exhibit behaviors including going to the bathroom everywhere in inappropriate places and wandering into other residents' rooms. Thirty-minute checks are ordered, and the log is at the nurse's station. They stated they are supposed to sign at each check, but they have not completed it for the last few days. During

an interview on 09/26/2025 at 10:45 AM, Registered Nurse Unit Manager #11 stated Resident #20 likes to wander and does enter other residents' rooms. They stated Resident #20 is easily redirected. They stated thirty-minute checks are ordered to monitor where Resident #20 is and redirect as needed. The checks should be completed, signed for, and omissions should not be there. They stated the Licensed Practical Nurse should be checking that thirty-minute checks are completed and signed for. During an interview on 09/26/2025 at 11:03 AM, the Assistant Director of Nursing stated Resident #20 does wanders and has an order for thirty-minute checks. They stated the checks are expected to be completed and signed for. During

an interview on 09/29/2025 at 10:54 AM the Director of Social Work stated the incident involving Resident #20 on 07/09/2025 was investigated and no findings of ill intent or harm were identified. Resident #20 does exhibit behaviors and can be distracted with music and activities. They stated there was a regular sitter in

the day room that was very helpful with redirection, activities, and monitoring, but they have not been here for some time. They stated they try to have unit assistants in the day room on the Apple Unit in addition to

the scheduled nursing staff for safety, engagement, and activity but they are not sure of their schedules.

During an interview on 09/29/2025 at 11:23 AM, the Assistant Director of Nursing stated unit assistants help with Resident #20 and monitor their behaviors in addition to nursing staff. They stated there was a time when their behaviors were worse. They stated unit assistants are scheduled on the Apple Unit but only for a few hours daily. During an interview on 09/29/2025 at 12:21 PM, Registered Nurse Unit Manager #11 stated the unit has unit assistants when they are available. They stated the unit assistants usually come in around 11AM and occasionally they have an assistant on evenings. They stated Resident #20 wanders and redirects easily, but staff are not always available to monitor all behaviors and wandering. They stated most residents on the unit are up and out of bed, so this minimizes possible resident to resident altercations when Resident #20 wanders into rooms. They stated they are trying to get more staff and may have more assistants in the future, but right now they do not have them on staff every day.10NYCRR

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Facility ID:

If continuation sheet