Apex Rehabilitation & Care Center

F-F839 Administration-Staff Qualifications

The finding is:

Executive Order Number 4.22 dated 6/8/2023 documented the Executive Order number 4 was extended until 6/22/2023 which included a temporary Suspension and Modification of Subdivision 5 of Section 6907 of the Education Law and Regulations to the extent necessary to permit graduates of registered professional nurse and licensed practical nurse licensure qualifying education programs registered by the State Education Department to be employed to practice nursing under the supervision of a registered professional nurse and with the endorsement of the employing hospital or nursing home for 180 days immediately following graduation.

The facility's undated policy titled Recruitment and Hiring, last revised on 4/2025, documented that it is the facility's policy to recruit professionals, direct care staff, and employees to meet the resident's needs, clinical needs, and operational needs in accordance with the facility assessment, current recruitments, and professional standards. The policy indicated that before the candidate starts their new job, the facility will conduct a background check to verify their license/certification, education, employment history, and any other relevant information including the criminal background check following State and Federal requirements.

The facility's policy titled Agency Hiring last revised in March 2023 documented the facility may engage staffing agencies to provide temporary or contract nursing personnel when internal staffing resources are insufficient to meet resident care needs. All agency nurses must meet the same standards of care, conduct, and compliance as employed staff. The policy indicated the credentialing and compliance prior to assignment, the agency must provide documentation for each nurse, and the HR/designee will verify all documentation before the nurse begins to work.

The facility's Agency Nurse Job Description documented qualifications that included a current, active nursing license in the state of assignment. Key responsibilities included administering medications and treatments as prescribed, monitoring residents for changes in condition, and reporting promptly to appropriate staff.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 21 of 31 335067 Department of Health & Human Services Printed: 08/28/2025 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 335067 B. Wing 04/16/2025

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

Apex Rehabilitation & Care Center 78 Birchwood Dr Huntington Station, NY 11746

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 0835 During an interview on 4/10/2025 at 12:03 PM, the Director of Human Resources/Assistant Administrator stated started working at the facility in February 2024 and had been calling the staffing agency to get the Level of Harm - Minimal harm or approved limited permits for the Medication/Treatment Nurses who are working at the facility as Unlicensed potential for actual harm Registered Nurses. The Director of Human Resources/ Assistant Administrator stated Medication/Treatment Nurse #1, Medication/Treatment Nurse #2 and Medication/Treatment Nurse #3 have been working at the Residents Affected - Some facility as Registered Nurses since 2021. Medication/Treatment Nurse #4 and Medication/Treatment Nurse #6 have been working at the facility as Registered Nurses since 2023. The Director of Human Resources/Assistant Administrator did not know why the facility allowed these nurses to work without a valid permit or New York State Registered Nurse license. The Director of Human Resources/ Assistant Administrator stated they continued to schedule the Medication/Treatment Nurses to work at the facility as Registered Nurses because the Nursing Department did not tell them to stop. The Director of Human Resources/ Assistant Administrator stated that the Director of Nursing Services and the Administrator were aware of the unlicensed nurses working at the facility in the capacity of Registered Nurses, as both the Director of Nursing Services and the Administrators were part of the emails that were sent to the staffing agency to obtain the nurses' license or limited permit information. The Director of Human Resources stated

they were not able to continue to follow up with the employees and the employees' agency to ensure appropriate credentials were obtained because they were busy with numerous other responsibilities at the facility.

During an interview on 4/10/2025 at 1:51 PM, the Director of Nursing Services stated all Medication/Treatment Nurses' job descriptions included Medication and Treatment Administration only. The Director of Nursing Services stated that Medication/Treatment Nurses who worked as unlicensed Registered Nurses should not be allowed to work at the facility without proper documentation. The Director of Nursing Services stated they have been working at the facility since 5/2023 and were aware of the unlicensed Nurses and how the Director of Human Resources/Assistant Administrator was trying to communicate with the staffing agency to obtain the approved credential for each of the nurses and was unsuccessful. The Director of Nursing Services stated they did not make it their priority to ensure the nurses had appropriate credentials available to work at the facility as Registered Nurses. They were so busy doing other things. The Director of Nursing Services stated Medication/Treatment Nurses who were identified as not having a New York State Registered Nurse license had been employed by the facility before the Director of Nursing Services was hired and they (the Director of Nursing Services) continued to schedule these Nurses as Medication and Treatment Nurses.

During an interview on 4/11/2025 at 11:27 AM, the Administrator stated that Medication/Treatment Nurse #1, Medication/Treatment Nurse #2, and Medication/Treatment Nurse #3 have been working at the facility as Registered Nurses since 2021. Medication/Treatment Nurse #4 and Medication/Treatment Nurse #6 have been working at the facility as Registered Nurses since 2023. The Administrator stated the unlicensed Medication/Treatment Nurses should not have been scheduled to work at the facility without proper documentation. The Administrator stated it was an oversight on their part, and it was not intentional. The Administrator stated they were not responsible for hiring and maintaining the employee files. The Administrator stated the Director of Human Resources/Assistant Administrator was responsible for ensuring and maintaining that each employee had appropriate credentials.

10 NYCRR 415.26

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 22 of 31 335067 Department of Health & Human Services Printed: 08/28/2025 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 335067 B. Wing 04/16/2025

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

Apex Rehabilitation & Care Center 78 Birchwood Dr Huntington Station, NY 11746

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 0839 Employ staff that are licensed, certified, or registered in accordance with state laws.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 49245 potential for actual harm Based on record review and interviews during the Recertification Survey and Abbreviated Survey Residents Affected - Some (Complaint# NY 00359457) initiated on [DATE REDACTED] and completed on [DATE REDACTED], the facility did not ensure professional staff were licensed, certified, or registered in accordance with applicable State laws. This was identified for five (Medication/Treatment Nurse #1, Medication/Treatment Nurse #2, Medication/Treatment Nurse #3, Medication/Treatment Nurse #4, and Medication/Treatment Nurse #6) of six employees reviewed for Licensure and Certification. Specifically, Medication/Treatment Nurse #1, Medication/Treatment Nurse #2, Medication/Treatment Nurse #3, Medication/Treatment Nurse #4, and Medication/Treatment Nurse #6 were working as Registered Nurses at the facility; however, all five employees did not have the required New York State Registered Nurse license and or approved limited permit to work as a Registered Nurse under the supervision of a licensed Registered Nurses.

The finding is:

The facility's undated policy titled Recruitment and Hiring, last revised on ,d+[DATE REDACTED], documented that it is

the facility's policy to recruit professionals, direct care staff, and employees to meet the resident's needs, clinical needs, and operational needs in accordance with the facility assessment, current recruitments, and professional standards. The policy indicated that before the candidate starts their new job, the facility will conduct a background check to verify their license/certification, education, employment history, and any other relevant information including the criminal background check following State and Federal requirements.

The facility's policy titled Agency Hiring last revised in [DATE REDACTED] documented the facility may engage staffing agencies to provide temporary or contract nursing personnel when internal staffing resources are insufficient to meet resident care needs. All agency nurses must meet the same standards of care, conduct, and compliance as employed staff. The policy indicated the credentialing and compliance prior to assignment, the agency must provide documentation for each nurse, and the HR/designee will verify all documentation

before the nurse begins to work.

The New York State Education Department (NYSED) website indicates under limited permit: that the New York State Education Department issues limited permits to nursing school graduates who have: 1) applied to

the New York State Education Department (NYSED) for licensure as a Registered Nurse and limited permit, and 2) Have met all requirements for licensure as Registered Nurse (RN) in New York State except for taking

the National Council License Examination for Registered Nurses (NCLEX-RN). A limited permit holder (called a Graduate Nurse or GN) can temporarily practice nursing under Registered Nurse supervision at the health care facility noted on the limited permit. The Graduate Nurse must be employed by the health care facility, and the supervising Registered Nurse must be on the care unit with the Graduate Nurse when the Graduate Nurse provides care. A limited permit is valid for up to one (1) year or until 10 days after the Graduate Nurse is notified that they failed the National Council License Examination for Registered Nurses (NCLEX-RN), whichever happens first. A Graduate Nurse who changes employers will have to obtain a new limited permit from the New York State Education Department (NYSED) to practice nursing for the new employer.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 23 of 31 335067 Department of Health & Human Services Printed: 08/28/2025 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 335067 B. Wing 04/16/2025

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

Apex Rehabilitation & Care Center 78 Birchwood Dr Huntington Station, NY 11746

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 0839 A Review of Medication/Treatment#1's personnel records indicated the employee was hired as a Registered Nurse. The limited permit application to work as a Registered Nurse in New York State was undated and Level of Harm - Minimal harm or incomplete. Medication/Treatment#1's personnel records did not have a current New York State Registered potential for actual harm Nurse license or documentation for a request or approval of a Limited Permit from the New York State Education Department. The personnel file contained a Foreign Nursing School Registered Nurse Diploma Residents Affected - Some dated [DATE REDACTED]. The personnel record did not include evidence of an initial job application or a background check for Medication/Treatment Nurse #1 as indicated in the facility policy.

A Review of Medication/Treatment#2's personnel file indicated that the employee was initially hired by the facility on [DATE REDACTED]. Medication/Treatment Nurse #2's personnel file indicated application for a limited permit to work as a Registered Nurse in New York State was incomplete, unsigned, and undated. There was no evidence of a New York State Registered Nurse license for Medication/Treatment#2.

A Review of Medication/Treatment #3's personnel file included an incomplete job application that was not signed and dated. There was no documentation of an approved limited permit to work as a Registered Nurse

in New York State. Medication/Treatment Nurse #3's personnel file included a Diploma for a Registered Nurse from a Foreign Nursing School dated [DATE REDACTED]. There was no evidence of a New York State Registered Nurse license for Medication/Treatment #3.

A Review of Medication/Treatment#4's personnel file did not have any documentation for an approved limited permit to work as a Registered Nurse in New York State. There was no evidence of a current Registered Nurse license for Medication/Treatment#4. The Office of the Inspector General (OIG) search (refers to the background check against the Health and Human Services Office of the Inspector General's list of excluded individuals/ entities) was completed on [DATE REDACTED] and the employee was not barred from participating in Federal healthcare programs like Medicare and Medicaid. Medication/Treatment Nurse #4's personnel file included a Diploma for a Registered Nurse from a Foreign Nursing School dated [DATE REDACTED]. Medication/Treatment #4's personnel record showed a National Council License Examination for Registered Nurses (NCLEX-RN) appointment that was rescheduled dated [DATE REDACTED].

A Review of Medication/Treatment #6's personnel file did not include an approved limited permit to work as a Registered Nurse in New York State. There was no evidence of a current New York State Registered Nurse license for Medication/Treatment #6. Medication/Treatment Nurse #6's personnel file included a Diploma for

a Registered Nurse from a Foreign Nursing School dated [DATE REDACTED]. Medication/Treatment Nurse #6's personnel file indicated they were approved to sit for the National Council License Examination for Registered Nurses (NCLEX-RN) as indicated in the email correspondence from the New York State Education Department dated [DATE REDACTED]. There was no indication that Council License Examination for Registered Nurses (NCLEX-RN) was completed and passed the examination.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 24 of 31 335067 Department of Health & Human Services Printed: 08/28/2025 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 335067 B. Wing 04/16/2025

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

Apex Rehabilitation & Care Center 78 Birchwood Dr Huntington Station, NY 11746

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 0839 During an interview on [DATE REDACTED] at 12:03 PM, the Director of Human Resources/Assistant Administrator stated started working at the facility in February 2024 and had been calling the staffing agency to get the approved Level of Harm - Minimal harm or limited permits for the Medication/Treatment Nurses who are working at the facility as Unlicensed Registered potential for actual harm Nurses. The Director of Human Resources/ Assistant Administrator stated Medication/Treatment Nurse #1, Medication/Treatment Nurse #2 and Medication/Treatment Nurse #3 have been working at the facility as Residents Affected - Some Registered Nurses since 2021. Medication/Treatment Nurse #4 and Medication/Treatment Nurse #6 have been working at the facility as Registered Nurses since 2023. The Director of Human Resources/Assistant Administrator did not know why the facility allowed these nurses to work without a valid permit or New York State Registered Nurse license. The Director of Human Resources/ Assistant Administrator stated they continued to schedule the Medication/Treatment Nurses to work at the facility as Registered Nurses because

the Nursing Department did not tell them to stop. The Director of Human Resources/ Assistant Administrator stated that the Director of Nursing Services and the Administrator were aware of the unlicensed nurses working at the facility in the capacity of Registered Nurses, as both the Director of Nursing Services and the Administrators were part of the emails that were sent to the staffing agency to obtain the nurses' license or limited permit information. The Director of Human Resources stated they were not able to continue to follow up with the employees and the employees' agency to ensure appropriate credentials were obtained because

they were busy with numerous other responsibilities at the facility.

During an interview on [DATE REDACTED] at 12:53 PM, Medication/Treatment Nurse #1, who worked at the facility as an Unlicensed Registered Nurse, stated they have been working at the facility since [DATE REDACTED] through an agency under a limited permit. They did not know when the limited permit application was approved. They went on

an extended leave in [DATE REDACTED] and came back to work at the facility in [DATE REDACTED]. They have not yet obtained their New York State Registered Nurse License. Medication/Treatment Nurse #1 stated their agency told them that the limited permit had ended; however, they were not able to recall the date the permit expired. Medication/Treatment Nurse #1 stated that they did not start the process of applying for the National Council License Examination for Registered Nurses (NCLEX-RN) examination to become a New York State licensed Registered Nurse because they were too busy.

Medication/Treatment Nurse #2, Medication/Treatment Nurse #3, Medication/Treatment Nurse #4, and Medication/Treatment Nurse #6 were not available for an interview.

During an interview on [DATE REDACTED] at 1:51 PM, the Director of Nursing Services stated all Medication/Treatment Nurses' job descriptions included Medication and Treatment Administration only. The Director of Nursing Services stated that Medication/Treatment Nurses who worked as unlicensed Registered Nurses should not be allowed to work at the facility without proper documentation. The Director of Nursing Services stated they have been working at the facility since ,d+[DATE REDACTED] and were aware of the unlicensed Nurses and how the Director of Human Resources/Assistant Administrator was trying to communicate with the staffing agency to obtain the approved credential for each of the nurses and was unsuccessful. The Director of Nursing Services stated they did not make it their priority to ensure the nurses had appropriate credentials available to work at the facility as Registered Nurses. They were so busy doing other things. The Director of Nursing Services stated Medication/Treatment Nurses who were identified as not having a New York State Registered Nurse license had been employed by the facility before the Director of Nursing Services was hired and they (the Director of Nursing Services) continued to schedule these Nurses as Medication and Treatment Nurses.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 25 of 31 335067 Department of Health & Human Services Printed: 08/28/2025 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 335067 B. Wing 04/16/2025

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

Apex Rehabilitation & Care Center 78 Birchwood Dr Huntington Station, NY 11746

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 0839 During an interview on [DATE REDACTED] at 11:27 AM, the Administrator stated that Medication/Treatment Nurse #1, Medication/Treatment Nurse #2, and Medication/Treatment Nurse #3 have been working at the facility as Level of Harm - Minimal harm or Registered Nurses since 2021. Medication/Treatment Nurse #4 and Medication/Treatment Nurse #6 have potential for actual harm been working at the facility as Registered Nurses since 2023. The Administrator stated the unlicensed Medication/Treatment Nurses should not have been scheduled to work at the facility without proper Residents Affected - Some documentation. The Administrator stated it was an oversight on their part, and it was not intentional. The Administrator stated they were not responsible for hiring and maintaining the employee files. The Administrator stated the Director of Human Resources/Assistant Administrator was responsible for ensuring and maintaining that each employee had appropriate credentials.

10 NYCRR 415.26(c)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 26 of 31 335067 Department of Health & Human Services Printed: 08/28/2025 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 335067 B. Wing 04/16/2025

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

Apex Rehabilitation & Care Center 78 Birchwood Dr Huntington Station, NY 11746

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 0842 Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 17732

Residents Affected - Few Based on record review and staff interviews during the Recertification Survey initiated on 4/8/2025 and completed on 4/16/2025, in accordance with accepted professional standards and practices, the facility did not maintain medical records on each resident that were complete. This was identified for one (Resident #151) of one resident reviewed for Dialysis. Specifically, there was no documented evidence in the treatment administration record that Resident #151's right chest Permacath (a long-term catheter used for dialysis treatment) was monitored every shift for signs and symptoms of bleeding, placement, and skin integrity.

The finding is:

The facility's policy titled Dialysis last reviewed in July 2023, documented that the shunt site (a surgically created connection between an artery and a vein, used for hemodialysis) or vascular access site will be checked every shift and documented on the Treatment Administration Record by the Nurse. The Nurse will check for bruit/thrill ( signs that the fistula or graft is working, and their presence is a positive indicator of healthy blood flow) at the shunt site and for any signs of infection and/or bleeding. The Nurse will check the vascular access site for any signs of bleeding or infection.

Resident #151 has diagnoses including End Stage Renal Disease and Cerebral Infarction (Stroke). The 5-Day Minimum Data Set (MDS) assessment dated [DATE REDACTED] documented that the resident had a Brief

Interview for Mental Status (BIMS) score of 15, which indicated the resident had intact cognitive skills for daily decision-making. The resident also received Hemodialysis while a resident of the facility and within the last 14 days.

The Comprehensive Care Plan titled Hemodialysis related to End Stage Renal Disease initiated on 1/23/2025 documented as an intervention: Right chest Permacath for Hemodialysis: Monitor for signs and symptoms for bleeding, monitor for placement and check skin integrity.

The Physician's Order dated 4/8/2025 documented that the resident was to receive in-house dialysis every Monday, Tuesday, Wednesday, Thursday, and Friday.

The Physician's Order dated 4/8/2025 documented for the Nurse to fill out the dialysis communication book prior to dialysis and review the book after the resident returns.

A review of the resident's medical record revealed there was no physician's order to monitor the right chest Permacath for signs and symptoms of bleeding, placement, and skin integrity.

A review of the resident's Dialysis Communication Book revealed the Permacath site was being monitored by

the facility staff before and after the resident's dialysis from Monday to Friday.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 27 of 31 335067 Department of Health & Human Services Printed: 08/28/2025 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 335067 B. Wing 04/16/2025

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

Apex Rehabilitation & Care Center 78 Birchwood Dr Huntington Station, NY 11746

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 0842 A review of the Progress Notes dated Saturday 4/12/2025 and Sunday 4/13/2025 (when the resident did not receive dialysis) revealed no documented evidence that the resident's right chest Permacath was monitored Level of Harm - Minimal harm or for signs and symptoms of bleeding, monitored for placement, and checked for skin integrity. potential for actual harm

During an interview on 4/14/2025 at 12:30 PM, Registered Nurse # 5 stated the resident should have had Residents Affected - Few Physician's Orders to monitor the right chest Permacath for signs and symptoms of infection, bleeding, and any abnormalities every shift. Registered Nurse #5 stated the admission nurse who readmitted the resident

on 2/10/2025 did enter the Physician's Orders into the computer for monitoring of the Permacath site. Registered Nurse #5 stated the orders must have been overlooked.

During an interview on 4/14/2025 at 12:55 PM, the Registered Nurse Supervisor (Registered Nurse #4) stated they readmitted the resident to the facility on [DATE REDACTED] and forgot to enter the order into the computer to monitor the resident's right chest Permacath for bleeding or signs of infection.

During an interview on 4/14/2025 at 1:20 PM, the Director of Nursing Services stated the Physician Orders to monitor the resident's right chest Permacath should have been entered into the computer by Registered Nurse #4 on 2/10/2025. If there was an order present, it would have been transcribed over to the Treatment Administration Record for the nurses to document.

During an interview on 4/15/2025 at 10:05 AM, Registered Nurse #2 stated they had worked the 7:00 AM - 3:00 shift on 4/12/2025 and 4/13/2025 and assessed the resident's right chest Permacath for any signs of infection, but did not document their assessment in the resident's medical record. Registered Nurse #2 stated they had seen other dialysis residents in the facility with physician orders to monitor their Permacath site, but not Resident #151. Registered Nurse #2 stated they never questioned why this resident did not have those orders.

10 NYCRR 483.70(i)(1)(i)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 28 of 31 335067 Department of Health & Human Services Printed: 08/28/2025 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 335067 B. Wing 04/16/2025

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

Apex Rehabilitation & Care Center 78 Birchwood Dr Huntington Station, NY 11746

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 Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 34798 potential for actual harm Based on observations, record review, and interviews during the Recertification Survey initiated on 4/8/2025 Residents Affected - Few and completed on 4/16/2025, the facility did not ensure it established an infection prevention and control program designed to help prevent the development and transmission of communicable diseases and infections for one (Resident #321) of one resident reviewed for Transmission-Based Precautions and for one (Resident #43) of five residents observed during the Medication Administration Task. Specifically, 1) Resident #321 had a Physician's order for Contact Precautions for Shingles (a rash caused by the virus that causes Chickenpox) with an antiviral medication; however, there was no Contact Precautions signage posted in a conspicuous location outside the resident's room that instructs staff and visitors for use of specific Personal Protective Equipment. 2) Medication/Treatment Nurse #2 did not perform hand hygiene

before putting on and removing their gloves when performing a finger stick blood glucose testing for Resident #43.

The findings are:

The facility's policy titled Infection Control/Infection Prevention and Control Program, dated 3/2024 documented the facility will establish and maintain an infection prevention and control program under which it prevents, identifies, reports, investigates, and controls the spread of infections and communicable diseases

in the facility. The facility decides when and how isolations should be applied to an individual resident.

Resident #321 was admitted with diagnoses including Schizophrenia, Malnutrition, and Acute Kidney Failure.

The 4/4/2025 Admission Minimum Data Set assessment documented a Brief Interview for Mental Status score of 3, indicating the resident had severe cognitive impairment.

A nursing progress note dated 4/4/2025 documented the resident being showered and there was a blistery rash noted on the right rib area extending to the front chest area. The physician was sent a picture (notified) and ordered Valtrex (an antiviral medication) 1 gram. The resident was placed in a private room for isolation purposes.

A physician's order dated 4/4/2025 documented Contact Precautions.

A physician's order dated 4/4/2025 documented Valtrex Oral Tablet 1 gram (an antiviral medication), give 1 tablet via Gastrostomy-Tube three times a day for Shingles for seven (7) days.

On 4/8/2025 at 12:50 PM Resident #321 was observed in their shared room. Resident #321 occupied the window bed. There was no Contact Precautions signage posted in a conspicuous location outside the resident's room that instructs staff and visitors to use specific Personal Protective Equipment.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 29 of 31 335067 Department of Health & Human Services Printed: 08/28/2025 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 335067 B. Wing 04/16/2025

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

Apex Rehabilitation & Care Center 78 Birchwood Dr Huntington Station, NY 11746

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 During an interview on 4/8/2025 at 12:55 PM, Registered Nurse #5 (the unit charge nurse) observed Resident #321's room entrance and stated the resident had a physician's order for Contact Precautions and Level of Harm - Minimal harm or there should be a Contact Precautions sign posted outside the resident's room. Registered Nurse #5 stated potential for actual harm on 4/4/2025 the resident was diagnosed with Shingles, was receiving Valtrex for seven days, and was moved to a private room for isolation. Yesterday (4/7/2025) the resident was moved back to their original Residents Affected - Few (current) room; however, the Contact Precaution sign was not re-posted outside the resident's current room when the resident was moved. Registered Nurse #5 stated the resident was still taking the antiviral treatment and had a physician's order to remain on Contact Precautions.

During an interview on 4/9/2025 at 2:47 PM, Registered Nurse Infection Preventionist #1 stated Resident #321 was started on Valtrex for seven days on 4/4/2025 for Shingles. The resident's room was changed on 4/4/2025 to be in a private room for contact isolation. On 4/7/2025 the Physician Assistant decided the resident could be moved back to their original room because the Shingles rash was dry, crusted over, and covered. Registered Nurse Infection Preventionist #1 stated the resident was supposed to remain on Contact Precautions while taking the Valtrex. Registered Nurse Infection Preventionist #1 stated the Contact Precaution sign was not moved to the resident's current room and it was an oversight.

During an interview on 4/10/2025 at 2:01 PM, the Director of Nursing Services stated Resident #321 had a physician's order to be placed on Contact Precautions for Shingles and a Contact Precautions signage should have been posted outside the resident's room. The Infection Preventionist and the nursing staff are responsible for making sure the Contact Precautions sign is present.

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2) The facility's policy titled Blood Glucose Monitoring, last revised on 12/2023, documented that finger stick glucose testing is ordered by the Physician. The Procedural Guidelines included performing hand hygiene and donning gloves. Clean the resident's fingertip or alternate site with alcohol preparation and allow to dry. Place the strip in the glucometer, pierce the resident's skin with a disposable lancet, and apply a drop of blood on the reagent strip. Remove gloves and perform hand hygiene. Wipe the machine surfaces, glucometer must be cleaned and disinfected between resident uses; to disinfect, wipe the glucometer with a germicidal disposable cloth and perform hand hygiene.

Resident #43 was admitted with diagnoses of Type 2 Diabetes, Dorsalgia (back pain), and Altered Mental Status. The Annual Minimum Data Set (MDS) assessment dated [DATE REDACTED] documented a Brief Interview for Mental Status (BIMS) score of 10, which indicated Resident #43 had moderately impaired cognition.

The Comprehensive Care Plan (CCP) dated 1/7/2025 documented that Resident #43 had Diabetes. Interventions included blood glucose monitoring as per the Physician's Order. Diabetic medication as per the Physician's order.

A Physician's Order dated 1/9/2025 documented Lantus (Insulin) Subcutaneous Solution 100 units per milliliter, Inject 30 units subcutaneously two times a day for Diabetes. Hold if fasting blood sugar is below 110 milligrams per deciliter and contact the Physician if fasting blood sugar is more than 350 milligrams per deciliter and below 70 milligrams per deciliter.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 30 of 31 335067 Department of Health & Human Services Printed: 08/28/2025 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 335067 B. Wing 04/16/2025

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

Apex Rehabilitation & Care Center 78 Birchwood Dr Huntington Station, NY 11746

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 During a Medication Administration Task with Medication/Treatment Nurse #2, who worked at the facility as

an Unlicensed Registered Nurse, on 4/9/2025 at 9:05 AM, Medication/Treatment Nurse #2 was observed Level of Harm - Minimal harm or conducting a finger stick blood glucose monitoring and administering insulin injection for Resident #43. potential for actual harm Medication/Treatment Nurse #2 brought the supplies to the resident's room, put on the gloves without washing their hands, and performed the finger stick blood glucose testing. Medication/Treatment Nurse #2 Residents Affected - Few administered the physician-ordered insulin to the resident, wiped the glucometer machine with a disposable germicidal cloth, and removed their gloves.

Medication/Treatment Nurse #2 did not perform hand hygiene. Medication/Treatment Nurse #2 gathered the used supplies (used for fingerstick and insulin injection) in a tray and put the tray on top of the medication cart. The Medication/Treatment Nurse #2 then proceeded to open the medication cart to administer Resident #43 their oral medications when the surveyor informed Medication/Treatment Nurse #2 to perform handwashing.

During an interview on 4/9/2025 at 9:15 AM, Medication/Treatment Nurse #2 stated they should have washed their hands before putting their gloves on and after they discarded the gloves to prevent the spread of any infection.

During an interview on 4/11/2025 at 2:23 PM, the Infection Preventionist stated that Medication/Treatment Nurse #2 should have washed their hands before putting their gloves on and after discarding their gloves.

During an interview on 4/15/2025 at 8:40 AM, the Director of Nursing Service stated that all staff must perform hand hygiene during resident care and other facility tasks. The Director of Nursing Service stated that handwashing prevents the spread of infection.

10 NYCRR 415.19(a)(1-3)(b)(4)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 31 of 31 335067