The Center For Nursing And Rehab At Hoosick Falls

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Administration Record dated 8/01/2025 to 8/20/2025, did not document an order for the wound on the resident's back. Review of the Medication Administration Record dated 8/01/2025 to 8/21/2025, did not document any wound treatment orders. Review of Nursing Progress Notes dated 8/04/2025 to 8/21/2025, did not document any notes about the new wound on the resident's back identified on 8/04/2025.Care Plan for Pressure Ulcer/Injury, revised 8/21/2025, documented the resident had actual skin impairment as evidenced by pressure ulcer to right heel and lateral foot, venous ulcers to right lower extremity, coccyx, and back. Approaches (interventions) included report any skin changes to provider as necessary; wound care treatment(s) as ordered.During an interview on 8/20/2025 at 1:53 PM, Assistant Director of Nursing #1 stated the facility's in-house wound care provider saw Resident #1 on 7/16/2025, and less than a week later, the resident's son wanted the resident to go to the hospital wound care center. Resident #1 usually returned with documentation from the hospital wound care center that was either given to them or Director of Nursing #1. Assistant Director of Nursing #1 reviewed the hospital wound care consult notes dated 8/04/2025, and stated there were six (6) wounds with treatments and there should be corresponding orders for all treatments in the computer system. They further stated, orders from the consult were entered in the computer system by them or Director of Nursing #1. The consult notes were then given to the Medical Records staff person to scan into the system. They stated the treatment orders would be documented on

the Medication Administration Record, as they did not have a separate Treatment Administration Record.During an interview on 8/21/2025 at 2:05 PM, Director of Nursing #1 stated Resident #1's wounds were being treated and monitored by the facility's wound care provider and then ultimately was sent out to

the hospital for wound care because the resident was refusing wound care. The resident had spina bifida and had a wound on their spine that closed last month (July 2025) and then reopened. Director of Nursing #1 reviewed the hospital wound care note dated 8/04/2025 and physician orders and stated, wound #6 was not identified by the facility and there was no order for the treatment. They stated typically the consultant would send the documentation with the treatment orders with the resident. There was a day when the resident came back from the wound consult and did not have paperwork. Sometimes the consult note was not dictated right away, and the facility would not receive the report until three (3) or four (4) days later. They reviewed the consult dated 8/04/2025, and stated it looked like it was faxed to the facility on 8/19/2025.

When consult notes were faxed, they were scanned into the computer system by the Medical Records staff person and then they would notify them that it was scanned. Director of Nursing #1 would then contact the physician and enter the order into the computer system. They stated best practice would be for the facility to call the wound care clinic when the resident returned without documentation. They stated Resident #1 was

the only resident in the facility who was sent out for wound care.During an interview on 8/21/2025 at 3:06 PM, Administrator #1 stated there was a delay in getting consult notes from the wound clinic and stated the wound clinic would not call the facility when they identified a new wound.During an interview on 8/22/2025 at 11:20 AM, Licensed Practical Nurse #2 stated wound care orders were documented in the computer system. When a resident returned from an outside wound consult, they would have paperwork that was given to the Assistant Director of Nursing #1 or Director of Nursing #1.During an interview on 8/22/2025 at 11:59 AM, Licensed Practical Nurse #3 stated they worked for an Agency, and it was their second time in

the building. They stated if a resident had a wound and was ordered to have a treatment, it would be documented in the computer system. If the resident went out of the facility for a wound consult, they would return with paperwork and they would inform Director of Nursing #1 or the Assistant Director of Nursing #1. 10 New Code of Rules and Regulations 415.12

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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

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Center for Nursing and Rehab at Hoosick Falls

21 Danforth Street Hoosick Falls, NY 12090

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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

order in the computer, they stated they would still do the care and document care was done in a progress notes. They stated there should be an order for daily catheter care for each resident who had a Foley catheter.During an interview on 8/22/2025 at 11:59 AM, Licensed Practical Nurse #3 stated residents with a Foley a catheter had orders in the computer for catheter care and flushing. If there were no catheter orders

they would tell the supervisor, and the supervisor would call the physician to obtain an order. 10 New York Code of Rules and Regulations 415.12(d)(1)

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