North Country Nursing & Rehabilitation Center

Federal health inspectors cited NORTH COUNTRY NURSING & REHABILITATION CENTER in MASSENA, NY for a deficiency under regulatory tag F-F0692 during a standard health inspection conducted on 2025-08-15.

Category: Quality of Life and Care Deficiencies

The facility was found deficient in the following area: Provide enough food/fluids to maintain a resident's health.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 5 deficiencies cited during this inspection of NORTH COUNTRY NURSING & REHABILITATION CENTER.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-18.

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

generic. A specific menu was programmed in the facility's Meal Tracker (specific electronic dietary program). Residents had a right to know what they were going to be eating on a routine basis. The posted menu met all residents' nutritional needs. The facility provided starches via mashed potatoes or rice. Butter or margarine was sent on the meal carts if a resident wanted them.During an interview on 8/15/2025 at 9:54 AM, Certified Nurse Aide #9 stated many residents complained about getting the same type of foods over and over. They stated the residents were served mashed potatoes or rice every day.During an

interview on 8/15/2025 at 10:15 AM, Certified Nurse Aide #10 stated the residents got a lot of the same types of foods. The residents complained that sometimes the food was cold, and staff had to heat it up or call the kitchen for a replacement. The staff ensured the food was not too hot, after reheating it, by taking

the food temperature before giving it to the resident. Some families brought food in they knew the residents would eat. Staff offered snacks and cereals when a resident did not eat the food.During an interview on 8/15/2025 at 10:39 AM, Licensed Practical Nurse #11 stated the residents complained about frequently getting the same types of food. They stated they had personally eaten the food in the past and it was bland.

The kitchen usually had sandwiches available if a resident did not like the main entree. During an interview

on 8/15/2025 at 11:00 AM, Food Service Director #1 stated the registered dietitian set the menu and signed off on approval. When asked to view the menu, the Food Service Director stated it was not readily available.

The menu was generic to make it appear neater. The menu was decided daily based on the available foods

in the kitchen. If there were vegetables and desserts on hand, that was adequate. They stated the food being served during survey was not always the posted menu as it was a very simple process of cooking the vegetables on hand. They stated the residents had a right to know exactly what the menu for each day would be. At 11:26 AM, the Food Service Director stated the facility did not have menus signed by the dietitian but was having them signed and sent to the facility.During an interview on 8/15/2025 at 11:03 AM, Licensed Practical Nurse #12 stated the residents received a lot of chicken. Mashed potatoes and vegetables were usually the same daily, and usually an assorted vegetable mix or just carrots. Most of the residents complained about getting the same thing all the time. They were able to have sandwiches as an alternate. During an interview on 8/15/2025 at 11:18 AM, the Director of Nursing stated alternates were listed on the menu for every meal. The facility also offered soup and sandwiches. They stated they were aware of residents complaining of getting the same types of meals. 415.4(c)(1-3)

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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

08/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

North Country Nursing & Rehabilitation Center

182 Highland Road Massena, NY 13662

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

machine not sanitizing properly before lunch and should have sanitized the dishes in the three-bay sanitizer

before using them. They stated dishes required sanitizing to get rid of bacteria. 10NYCRR 483.60(i)(2)

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

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

Event ID:

Facility ID:

If continuation sheet

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

08/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

North Country Nursing & Rehabilitation Center

182 Highland Road Massena, NY 13662

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)

Federal health inspectors cited NORTH COUNTRY NURSING & REHABILITATION CENTER in MASSENA, NY for a deficiency under regulatory tag F-F0814 during a standard health inspection conducted on 2025-08-15.

Category: Nutrition and Dietary Deficiencies

The facility was found deficient in the following area: Dispose of garbage and refuse properly.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 5 deficiencies cited during this inspection of NORTH COUNTRY NURSING & REHABILITATION CENTER.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-18.

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and

the public.

Based on observations and interviews during the recertification survey conducted 8/11/2025- 8/15/2025,

the facility did not ensure a safe, functional, sanitary, and comfortable environment for residents, staff, and

the public in one (1) of (3) three units (Unit 200). Specifically, Unit 200 hallway was unclean and had odors.Findings include: The undated facility Housekeeping Tasks documented hallways/nurse's station should be dust mopped and wet mopped. The following observations were made on Unit 200:- On 8/11/2025 at 4:12 PM, there was a brown, dried, odorous substance smeared on the floor going down the hallway from the elevators to the shower room.- On 8/12/2025 at 8:52 AM, there was a brown dried, odorous substance on the floor in the hallway near the elevators. During an interview on 8/14/2025 at 10:07 AM, Housekeeper #2 stated they were responsible for sweeping, mopping, cleaning windowsill, and wiping down everything. They stated they were responsible for mopping the hallways every day, but they did not always get to them. Feces on the floors should be cleaned up by nursing staff. They stated they saw a brown streak down the hallway near the elevator. During an interview on 8/14/2025 at 2:30 PM, the Infection Preventionist stated the certified nurse aides were responsible for cleaning up feces on the floor and housekeeping would sanitize the area afterward. During an interview on 8/14/2025 at 2:45 PM, Certified Nurse Aide #4 stated if they observed feces and urine on the floor, they were responsible for cleaning up the feces or urine.10NYCRR 415.29

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If continuation sheet