Riverdale Nursing Home

F-F658 Services Meet Professional Standards

The findings are:

The facility policy titled Laboratory and Diagnostic Test Results with a revised date of 01/2025 documented that the Physician will identify and order diagnostic and laboratory testing based on the resident's diagnostic and monitoring needs. The staff will process test requisitions and arrange for tests. The laboratory, diagnostic radiology provider or other testing source will report test results to the facility. Physicians or nurses who have concerns about how test results have been handled or reported should communicate such concerns to the Director of Nursing and/or the Medical Director. Such concerns or disagreements should not prevent timely, clinically appropriate management of a current result or clinical situation.

The facility policy titled Physician Services with a reviewed date of 01/2025 documented that the physician will address laboratory and other diagnostic test results in a timely manner based on the resident's condition and the clinical significance of the results. The physician will periodically review all medications prescribed for their patients and will monitor both for continuing indications and for possible adverse drug reactions. The medication review should take into account observations and concerns offered by pharmacy consultants and others regarding beneficial and possible adverse impacts of medications on the resident. The attending physician will perform accurate, timely and relevant assessments as needed. The physician will respond to notification of and will assess and manage acute and significant changes in resident condition.

Resident #39 had diagnoses of Non-Alzheimer's Dementia and Schizoaffective Disorder.

The quarterly Minimum Data Set assessment dated [DATE REDACTED] documented Resident #39 had moderately impaired cognition and had received anticonvulsive and antipsychotic medications since admission/entry or reentry into the facility.

A physician order which was initiated on 01/25/2023 and renewed on 02/25/2025 documented a medication order for Depakote Sprinkles 125 milligram capsules, delayed release, 5 capsules (625 milligrams) to be administered by oral route 3 times a day with food.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 21 of 24 335096 Department of Health & Human Services Printed: 09/04/2025 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 335096 B. Wing 03/19/2025

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

New Riverdale Rehab and Nursing 641 West 230th St Bronx, NY 10463

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 0711 A Medication Administration Record dated March 2025 documented that Resident #39 was administered 625 milligrams of Depakote Sprinkles by oral route 3 times a day. Level of Harm - Minimal harm or potential for actual harm A care plan for psychotropic use was initiated for Resident #39 which was last reviewed on 03/07/2025. The facility interventions include to monitor laboratory results for drug levels. Residents Affected - Few

A Pharmacy Consultant Medication Regimen Review progress note dated 02/11/2025 documented Resident #39 was currently receiving Depakote, unable to locate a recent serum level in the chart, recommended 2 weeks after start then every 6 months thereafter. The note documented to please consider ordering.

A Medication Regimen Review Response progress note dated 02/12/2025 documented the Nurse Practitioner's response to the Consultant Pharmacist's recommendation for Resident #39 as follows -Agree Will do.

A Physician Laboratory Order dated 02/12/2025, documented Depakene - Serum Valproate one time 02/13/2025.

There was no documented evidence that the serum level for Depakote was drawn.

There was no documented evidence that the physician or the nurse practitioner followed up if the serum level has been completed.

On 03/19/2025 at 9:23 AM, the Nurse Practitioner was interviewed and stated that Depakote level was ordered for Resident #39 on 02/12/2025 as recommended by the pharmacy consultant. The Nurse Practitioner stated they wait for the Registered Nurse to inform them of the laboratory test results. They stated they were not notified of the results or the reason why was the serum level not obtained.

On 03/19/2025 at 12:23 PM, the Medical Director was interviewed and stated the Nurse Practitioner should have followed up timely when they had not received the laboratory results.

10 NYCRR 415.15 (b)(2)(iii)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 22 of 24 335096 Department of Health & Human Services Printed: 09/04/2025 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 335096 B. Wing 03/19/2025

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

New Riverdale Rehab and Nursing 641 West 230th St Bronx, NY 10463

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 0756 Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 48876

Residents Affected - Few Based on record review and interviews during the Recertification Survey conducted from 03/12/2025 to 03/19/2025, the facility failed to address an irregularity identified during Drug Regimen Review to minimize or prevent adverse consequences. This was evident in 1 Resident (Resident #39) of 5 residents reviewed for Unnecessary Medications and Medication Regimen Review. Specifically, on 02/11/2025, the pharmacy consultant recommended Depakote serum level for Resident #39. There was no evidence that the serum level has been obtained.

The findings are:

The facility policy titled Drug Regimen Review with a revised date of 03/2025 documented that in accordance with Code of Federal Regulations 42 CFR 483.45, the Consultant Pharmacist shall review the medical record of each resident and perform a Drug Regimen Review at least once each calendar month. The Consultant Pharmacist shall identify, document, and report possible medication irregularities for review and action by the attending Physician, where appropriate. The attending Physician or licensed designee shall respond to the Drug Regimen Review within 30 days or more promptly whenever possible and act upon the Drug Regimen

Review Findings/recommendation in a timely manner of 30 days or less by documenting on the drug regimen

review form whether they agree or disagree with the recommendation.

The facility policy titled Laboratory and Diagnostic Test Results with a revised date of 01/2025 documented that the physician will identify and order diagnostic and laboratory testing based on the resident's diagnostic and monitoring needs. The staff will process test requisitions and arrange for tests. The laboratory, diagnostic radiology provider or other testing source will report test results to the facility. Physicians or nurses who have concerns about how test results have been handled or reported should communicate such concerns to the Director of Nursing and/or the Medical Director. Such concerns or disagreements should not prevent timely, clinically appropriate management of a current result or clinical situation.

Resident #39 had diagnoses of Non-Alzheimer's Dementia and Schizoaffective Disorder.

The quarterly Minimum Data Set assessment dated [DATE REDACTED] documented Resident #39 had moderately impaired cognition and had received anticonvulsive and antipsychotic medications since admission/entry or reentry into the facility.

A physician order which was initiated on 01/25/2023 and renewed on 02/25/2025 documented a medication order for Depakote Sprinkles 125 milligram capsules, delayed release, 5 capsules (625 milligrams) to be administered by oral route 3 times a day with food.

A care plan for psychotropic use was initiated for Resident #39 which was last reviewed on 03/07/2025. The facility interventions include to monitor laboratory results for drug levels.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 23 of 24 335096 Department of Health & Human Services Printed: 09/04/2025 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 335096 B. Wing 03/19/2025

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

New Riverdale Rehab and Nursing 641 West 230th St Bronx, NY 10463

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 0756 A Pharmacy Consultant Medication Regimen Review progress note dated 02/11/2025 documented Resident #39 was currently receiving Depakote, unable to locate a recent serum level in the chart, recommended 2 Level of Harm - Minimal harm or weeks after start then every 6 months thereafter. The note documented to please consider ordering. potential for actual harm

A Medication Regimen Review Response progress note dated 02/12/2025 documented the Nurse Residents Affected - Few Practitioner's response to the Consultant Pharmacist's recommendation for Resident #39 as follows -Agree Will do.

A Physician Laboratory Order dated 02/12/2025, documented Depakene - Serum Valproate one time 02/13/2025.

There was no documented evidence that the serum level for Depakote was drawn.

On 03/19/2025 at 9:23 AM, the Nurse Practitioner was interviewed and stated that Depakote level was ordered for Resident #39 on 02/12/2025 as recommended by the pharmacy consultant. The Nurse Practitioner stated they wait for the Registered Nurse to inform them of the laboratory test results. They stated they were not notified of the results or the reason why was the serum level not obtained.

On 03/19/25 at 10:58 AM, the Director of Nursing was interviewed and stated if the sample was not collected, the laboratory should communicate with the nurse. The Director of Nursing stated a follow up should have been done for laboraory requests that were not completed.

10 NYCRR 415.18(c)(2)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 24 of 24 335096

F-F711 Physician Visits - Review Care/notes/order

The findings are:

The facility policy titled Laboratory and Diagnostic Test Results with a revised date of 01/2025 documented that the Physician will identify, and order diagnostic and laboratory testing based on the resident's diagnostic and monitoring needs. The staff will process test requisitions and arrange for tests. The laboratory, diagnostic radiology provider or other testing source will report test results to the facility. Physicians or nurses who have concerns about how test results have been handled or reported should communicate such concerns to the Director of Nursing and/or the Medical Director. Such concerns or disagreements should not prevent timely, clinically appropriate management of a current result or clinical situation.

Resident #39 had diagnoses of Non-Alzheimer's Dementia and Schizoaffective Disorder.

The quarterly Minimum Data Set assessment dated [DATE REDACTED] documented Resident #39 had moderately impaired cognition and had received anticonvulsive and antipsychotic medications since admission/entry or reentry into the facility.

A physician order which was initiated on 01/25/2023 and renewed on 02/25/2025 documented a medication order for Depakote Sprinkles 125 milligram capsules, delayed release, 5 capsules (625 milligrams) to be administered by oral route 3 times a day with food.

A Medication Administration Record dated March 2025 documented that Resident #39 was administered 625 milligrams of Depakote Sprinkles by oral route 3 times a day.

A care plan for psychotropic use was initiated for Resident #39 which was last reviewed on 03/07/2025. The facility interventions include to monitor laboratory results for drug levels.

A Pharmacy Consultant Medication Regimen Review progress note dated 02/11/2025 documented Resident #39 was currently receiving Depakote, unable to locate a recent serum level in the chart, recommended 2 weeks after start then every 6 months thereafter. The note documented to please consider ordering.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 17 of 24 335096 Department of Health & Human Services Printed: 09/04/2025 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 335096 B. Wing 03/19/2025

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

New Riverdale Rehab and Nursing 641 West 230th St Bronx, NY 10463

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 0658 A Medication Regimen Review Response progress note dated 02/12/2025 documented the Nurse Practitioner's response to the Consultant Pharmacist's recommendation for Resident #39 as follows -Agree Level of Harm - Minimal harm or Will do. potential for actual harm

A Physician Laboratory Order dated 02/12/2025, documented Depakene - Serum Valproate one time Residents Affected - Few 02/13/2025.

There was no documented evidence that the serum level for Depakote was drawn.

There was no documented evidence that the licensed nurses, physician, or the nurse practitioner followed up if the serum level has been completed.

On 03/19/2025 at 9:23 AM, the Nurse Practitioner was interviewed and stated that Depakote level was ordered for Resident #39 on 02/12/2025 as recommended by the pharmacy consultant. The Nurse Practitioner stated they wait for the Registered Nurse to inform them of the laboratory test results. They stated they were not notified of the results or the reason why was the serum level not obtained.

On 03/19/2025 at 12:23 PM, the Medical Director was interviewed and stated the Nurse Practitioner should have followed up timely when they had not received the laboratory results.

On 03/19/2025 at 10:58 AM, the Director of Nursing was interviewed and stated that the expectation was that

the attending physician or rhe nurse practitioner will follow up on the laboratory results.

10 NYCRR 415.11(c)(3)(i)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 18 of 24 335096 Department of Health & Human Services Printed: 09/04/2025 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 335096 B. Wing 03/19/2025

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

New Riverdale Rehab and Nursing 641 West 230th St Bronx, NY 10463

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 0692 Provide enough food/fluids to maintain a resident's health.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 18881 potential for actual harm Based on observation, record review, and interview during the Recertification Survey conducted from Residents Affected - Few 03/12/2025 to 03/19/2025, the facility did not ensure that a resident maintains acceptable parameters of nutritional status, such as usual body weight or desirable body weight range unless the resident's clinical condition demonstrates that this is not possible or resident preferences indicate otherwise. This was evident

in 1 (Resident #122) of 5 residents reviewed for nutrition. Specifically, Resident #122 had significant weight loss of greater than 7.5 % in the last 3 months from November 2024 through February 2025 with no proactive interventions.

The findings are:

The facility policy titled Weight Policy with a revision date of 03/2025 documented the purpose of this procedure are to determine the resident's weight and height, to provide a baseline and an ongoing record of

the resident's body weight as an indicator of the nutritional status and medical condition of the resident, and to provide a baseline height in order to determine the idea weight of the resident.

Resident #122 had diagnoses of Hypertension, Unspecified Protein Calorie Malnutrition, and Right Below Knee Amputation and Right Foot Burn.

The Minimum Data Set assessment dated [DATE REDACTED] documented Resident #122 had intact cognition and required minimal assistance and supervision with activities of daily living.

A review of the Comprehensive Care Plan on Nutritional Status dated 09/22/2024 documented Resident #122 was at risk for nutrition related problem secondary to diagnosis of thiamine and vitamin deficiency. The goal set was nutrition - related laboratories results will be at baseline for medical condition, will be free from chewing and swallowing difficulties, will increase 1-2 pounds weight gradually and Per Orem intake will be sufficient to support nutrition and hydration needs. The interventions were listed as follows: consult with physician as needed, consult with dietician as needed , daily calorie needs based on ideal Body weight of 148 pounds or 67 kilograms. The total calorie needs was calculated at 1675-2010 total calorie needs, 67 grams of protein and 1657 to 2101 milliliter of fluids, to monitor food consumption during mealtimes, and monitor weekly weight.

A review of the resident's weight from 11/29/2024 to 02/28/2025 showed an undesirable weight loss of 12%

in the last 3 months.

11/29/2024 - 133 pounds

12/13/2024 - 125.2 pounds

12/20/2024 - 134 pounds

12/27/2024 - 133.9 pounds

01/03/2025 - 116.6 pounds

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 19 of 24 335096 Department of Health & Human Services Printed: 09/04/2025 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 335096 B. Wing 03/19/2025

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

New Riverdale Rehab and Nursing 641 West 230th St Bronx, NY 10463

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 0692 01/10/2025 - 116 pounds

Level of Harm - Minimal harm or 01/24/2025 - 116.1 pounds potential for actual harm 02/28/2025 - 117 pounds Residents Affected - Few

A review of Resident #122's care plan and dietary notes revealed no intervention to address the significant weight loss of 17.3 pounds in January 2025.

The 03/11/2025 3:51 PM dietary progress note documented Resident #122 had significant and undesirable weight loss of 16 pounds, 12% in 3 months; 20.4 pound weight loss, 14.8% in 5 months. Weight is pending for March. The dietary note documented, weight loss was discussed with the resident who acknowledged he has good appetite and that they were losing weight prior to admission due to their illness. The plan was to monitor intake and weekly weights.

During an interview with the Registered Dietician on 03/14/2025 at 12:06 PM, they stated they have not seen Resident #122's January and February weight record and was informed of the weight loss in March. They stated they only come to the facility twice a week and cannot do everything.

During an interview with Nurse Practitioner #1 on 03/14/2025 at 12:51 PM, they stated they were not aware of Resident #122's weight loss until March. They stated they do not remember anybody discussing the resident's weight loss with them. They stated that the recommendations to manage weight loss should come from the dietitian.

During an interview with the Assistant Director of Nursing on 03/14/2025 at 1:14 PM, they stated changes in

a resident's diet and weight loss are discussed during the morning meeting and is communicated to the dietary department. They stated weight records are on the resident's notes and can be reviewed by the dietitian.

10 NYCRR 415.12 (i)(1)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 20 of 24 335096 Department of Health & Human Services Printed: 09/04/2025 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 335096 B. Wing 03/19/2025

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

New Riverdale Rehab and Nursing 641 West 230th St Bronx, NY 10463

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 0711 Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 48876

Residents Affected - Few Based on record review and interview during the Recertification Survey conducted from 03/12/2025 to 03/19/2025, the facility did not ensure that the physician reviewed the resident's total program of care, including medications and treatments, at each visit. This was evident in 1 (Resident #39) of 5 residents reviewed for Unnecessary Medications and Medication Regimen Review. Specifically, the Nurse Practitioner failed to follow up on the results of a serum Depakote level ordered on 02/12/2025.

Cross Reference: