Brooklyn Gardens Nursing & Rehabilitation Center

F 0577 On 05/23/2025 at 8:33 AM, the Administrator was interviewed and stated the last time they observed the signage on the availability of survey reports in the lobby was in 04/2025. They stated they were surprised Level of Harm - Potential for that the posting was not there. The Administrator further stated that someone must have removed the minimal harm posting and that they have reposted the signage and will increase their auditing of the location to ensure compliance. Residents Affected - Many 10 NYCRR 415.3 (d)(1)(v)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 2 of 9 335070 Department of Health & Human Services Printed: 08/26/2025 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 335070 B. Wing 05/29/2025

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

Brooklyn Gardens Nursing & Rehabilitation Center 835 Herkimer Street Brooklyn, NY 11233

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 0694 On [DATE REDACTED] at 3:39 PM, the Medical Director was interviewed and stated that the medical providers / attending physicians must review the order for accuracy and completeness on the same day the orders are Level of Harm - Minimal harm or written and must be signed off. The Medical Director stated if there were inaccuracies in the physician's potential for actual harm orders, the Director of Nursing may reach out to them to discuss the issues

Residents Affected - Some 10 NYCRR 415.12(k)(2)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 6 of 9 335070 Department of Health & Human Services Printed: 08/26/2025 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 335070 B. Wing 05/29/2025

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

Brooklyn Gardens Nursing & Rehabilitation Center 835 Herkimer Street Brooklyn, NY 11233

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 0812 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food

in accordance with professional standards. Level of Harm - Minimal harm or potential for actual harm 42101

Residents Affected - Few Based on observation, record review, and interviews during the Recertification Survey conducted from 05/21/2025 to 05/29/2025, the facility did not ensure that food was handled in accordance with professional standards for food service safety and staff did not ensure that infection control practices were maintained in

the kitchen. Specifically, Dietary Staff #1 and #2 were observed with visible facial hair while handling and preparing food.

The findings include:

The undated facility policy titled Sanitation and Food Safety - Staff Appearance and Hygiene documented hair will be clean and worn pulled back up if longer than shoulder length. Regardless of length, hairnet or approved chef type hat is required in all production and service areas. Facial hair or of any length or design must be covered by a beard guard.

During a tray line observation on 05/23/2025 from 11:48 AM- 12:25 PM the following were observed:

Dietary Aide #1 was observed with hair restraint and gloves, with a visible mustache and goatee (chin beard) while putting silverwares into a utensil holder opposite the sandwich making station and the cooking area.

They were also observed scooping and placing watermelons in plastic cups.

Dietary Aide #2 was observed on the tray line with their beard guard below their mustache while handling food side items such as vegetables, fish, white rice, chicken wing, chopped fish, green beans.

During an interview on 05/23/2025 at 12:22 PM, Dietary Aide #1 stated they forgot to put their beard cover when they went to the kitchen. Dietary Aide #1 stated they were supposed to wear beard covering when handling food to make sure hair does not drop in food or utensils.

During an interview on 05/23/2025 at 12:25 PM, Dietary Aide #2 stated they were instructed by their previous supervisor to only cover the bottom part of their face.

During an interview on 05/28/2025 at 11:24 PM, the Food Service Supervisor stated dietary staff with beard and mustache should be wearing beard guards, so hair does not get into residents' food.

During an interview on 05/28/2025 at 11:33 AM, the Food Service Director stated that the required uniform in

the kitchen includes the use of hair restraint and beard guard for people with mustache and beard. They stated all facial hair must be covered for infection control and to avoid dropping hair in residents' food during preparation.

10 NYCRR 415.14(h)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 7 of 9 335070 Department of Health & Human Services Printed: 08/26/2025 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 335070 B. Wing 05/29/2025

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

Brooklyn Gardens Nursing & Rehabilitation Center 835 Herkimer Street Brooklyn, NY 11233

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 On 05/28/2025 at 11:14 AM, the Director of Nursing/Infection Preventionist was interviewed and stated staff received in-service education on infection control and enhanced Barrier Precautions. These in-services are Level of Harm - Minimal harm or conducted during orientation and annually. The Director of Nursing stated Licensed Practical Nurse #1 is potential for actual harm newly hired, still on probation, and was recently given these in-services. The Director of Nursing stated that there are signages posted on the units to let staff know if a resident is on enhanced barrier precautions. They Residents Affected - Few stated they were surprised that Licensed Practical Nurse #1 stated they had not seen it.

10 NYCRR 415.19 (b)(4)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 9 of 9 335070