Grand Manor Nursing & Rehabilitation Center
Grand Manor Nursing & Rehabilitation Center in Bronx, NY — inspection on February 24, 2026.
Found 3 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
02/24/2026 based on the following corrective actions taken by the facility: 1.
The Director of Nursing
jeopardy to resident health or .
The review confirmed ten (10) residents (Residents #2, 16, 28, 49, 50, 53, 114, 142, 146, 177) with safety discrepancies of dosage between the physician's orders and the labeled methadone bottles.
These 10 residents were clinically assessed and found to have no signs and symptoms of toxicity or any
prescribed methadone dose and frequency.
This was completed on 02/24/2026. 3.
The Director of Nursing contacted the Medical Director and obtained telephone orders to ensure the physician's orders correspond with the doses on the methadone bottles. 4.
The Pharmacy Consultant completed a regimen review of residents prescribed methadone on 02/18/2026.
The audit revealed that all previous discrepancies were corrected and there were no other discrepancies identified.5. A new policy and procedure on methadone administration, order verification, reconciliation, and chain of custody was created and reviewed by the Administrator, Medical Director, and the Director of Nursing.
The facility's Methadone administration order verification and reconciliation policy, establishes a formal, documented chain-of-custody process for methadone received from the external opioid treatment programs.The procedure addresses the implementation of the Reconciliation and Chain of Custody Receipt Form which documents methadone disposition from the methadone clinic to the facility.
The methadone clinic program is now required to complete the reconciliation and chain of custody form when providing methadone bottles to the facility/escort, accounting for the number of bottles dispensed and any changes in the dosage or frequency of methadone as prescribed by the program.
Upon facility receipt of the form and the medication on the unit, the license nurse will reconcile the received medication with the facility physician's order. In the event a discrepancy is identified, the licensed nurse will notify the RN supervisor to contact the opioid treatment program to verify the change.
The RN supervisor will notify the attending physician and request an updated and accurate medication order.
The discrepancy and resolution will be documented in nursing progress notes in the electronic medical record.
The receipt of Methadone disposition will be signed by the escort upon receipt at the location of the program and will be signed by the receiving licensed nurse at the facility.
The licensed nurse will provide the Reconciliation and Chain of Custody Receipt Form to the Registered Nurse Supervisor and will be filed in a binder to be kept in the nursing office for record and verification.This policy was effective on 02/14/2026.6.
All licensed nurses, attending physicians, the pharmacy consultant, and the facility escorts received in-service on the new policy. 10 New York Codes, Rules, and Regulations 80.7510 New York Codes, Rules, and Regulations 415.18(a)
335744 02/24/2026
Grand Manor Nursing & Rehabilitation Center 700 White Plains Road Bronx, NY 10473
During an interview on 02/12/2026 at 10:11 AM, the Director of Nursing stated the methadone clinic determines the methadone dosage and frequency for the residents.
They stated the resident is escorted to the methadone clinic to pick up the medication.
When they return, they hand the medication over to the unit nurse.
The unit nurse calls the attending physician with the dosage then enters the order in the electronic medical record.
The Director of Nursing stated there is no receipt or other paperwork received from the clinic.
During an interview on 02/11/2026 at 1:00 PM, the Medical Director stated they have residents in the facility that are on a methadone maintenance program.
They stated they do not know the process by which the methadone is delivered to the facility.
They stated that the methadone dosage is determined by the methadone clinic.
They stated the methadone clinic sends a report to the facility indicating the dosage and frequency for each resident, and the nurse enters it in the electronic medical record under physician's order.
The Medical Director stated they electronically sign the orders without looking at the report.
They stated their only responsibility is to assess the residents and renew the orders.
During a follow-up interview with the Medical Director on 02/13/2026 at 2:51 PM, they indicated that the lack of established processes and communication between the facility and the methadone clinic represents a system failure. 10 New York Codes, Rules, and Regulations 415.12 (m)(2)
335744 02/24/2026
Grand Manor Nursing & Rehabilitation Center 700 White Plains Road Bronx, NY 10473
During an interview on 02/12/2026 at 11:33 AM, Attending Physician #1 stated they have residents on methadone maintenance program.
They stated they are unsure what methadone dosage each resident is supposed to receive.
However, the residents must receive the dosage indicated on the methadone bottle.
Attending Physician #1 further stated that the physician's order and the dosage labeled on the methadone bottle do not necessarily need to match for the nurse to administer the medication.
During an interview on 02/11/2025 at 1:00 PM, the Medical Director stated they have residents in the facility that are on methadone maintenance programs.
They stated they did not know the process by which the methadone is delivered to the facility.
They stated that the methadone dosage is determined by the methadone clinic.
They stated the methadone clinic sends a report to the facility indicating the dosage and frequency for each resident, and the nurse enters it in the electronic medical record under physician's order.
The Medical Director stated they electronically sign the orders without looking at the report and that their only responsibility is to assess the residents and renew the orders.
During a follow-up interview with the Medical Director on 02/13/2026 at 2:51 PM, they indicated that the lack of established processes and communication between the facility and the methadone clinic represents a system failure. 10 New York Codes, Rules, and Regulations 415.15 (a)