Dry Harbor Nursing Home

F-F583 s/s D Residents Affected - Few Based on observation, record review, and interviews conducted during an abbreviated survey (NY00358147), the facility failed to ensure a resident was treated with respect and dignity including the right to privacy and confidentiality. This was evident in one out of three residents (Resident #4) sampled. Specifically, on 10/22/2024 (time not specified),

Certified Nursing Assistant #3 did not obtain consent to record or post Resident #4 on their social media account.

On 10/22/2024, Certified Nursing Assistant # 4 reported to Risk Manager #2 that they saw a post on Certified Nursing Assistant #3's Tik Tok social media account with Resident #4. The facility's investigation dated 10/22/2024, included a statement from Certified Nursing Assistant #3 documented they posted Resident #4

on their social media account.

This resulted in Past Noncompliance with no potential harm.

The findings include:

The facility's Prevention of Abuse, Neglect, Exploitation, and Misappropriation policy and procedure revised 09/2023, documented the facility shall prevent any mistreatment, abuse, or neglect of residents. The policy further documented in Procedure section VI Exploitation, no staff member can take pictures or videos anywhere in the facility. Residents cannot be viewed in the forefront or background of any picture or video.

Resident #4 was admitted to the facility with diagnoses including Hypertension, Non-Alzheimer's Dementia and Depression.

The Minimum Data Set (an assessment tool), dated 10/17/2024, documented Resident #4 had a Brief

Interview of Mental Status (used to determine attention, orientation, and ability to recall information) score of three, Resident #4 was severely impaired cognition.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 1 of 3 335416 Department of Health & Human Services Printed: 09/10/2025 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 335416 B. Wing 01/27/2025

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

Dry Harbor Nursing Home 61 35 Dry Harbor Road Middle Village, NY 11379

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 0583 The facility's investigation dated 10/22/2024, documented there were no harm intended on Certified Nursing Assistant #3's video post on their social media account, however, Certified Nursing Assistant #3 did not Level of Harm - Minimal harm or receive consent from Resident #4. Resident #4 was unaware of what happened and was unable to retain potential for actual harm that information. There were no negative effects on Resident #4's emotional, psychosocial, and physical well-being. Certified Nursing Assistant #3 was terminated immediately, Resident #4's next of kin was Residents Affected - Few informed and a full house in-service was conducted on the abuse policy.

Statement of Occurrence (no date specified) by Certified Nursing Assistant #3 documented they chose to post Resident #4 on their social media because Resident #4 expressed appreciation. Certified Nursing Assistant #3 also wanted people to see how great it was to be a Certified Nursing Assistant. Statement further documents Certified Nursing Assistant #3 received positive and negative feedback and so they removed the post three days later when they received comments that they violated the Health Insurance Portability and Accountability Act (law that protects patient's sensitive health information).

Several attempts made to interview Certified Nursing Assistant #3 but was unsuccessful, letter was mailed

on 01/21/2025.

During a telephone interview on 01/23/2025 at 9:12 AM, Director of Nursing stated on 10/22/2024, (cannot recall the time) Risk Manager #2 informed them of a TikTok social media involving Resident #4 and Certified Nursing Assistant #3. Director of Nursing stated they informed the Administrator and had a meeting with the department heads and then spoke with Certified Nursing Assistant #3. Certified Nursing Assistant #3 showed them the original video that was posted. Certified Nursing Assistant #3 stated the post depicted the life of a Certified Nursing Assistant and how they take care of Resident #4. The Director of Nursing stated Certified Nursing Assistant #3 was terminated on 10/22/2024.

The Director of Nursing stated in-services about dignity, social media and videos was done for all staff starting on 10/22/2024, and continued until all staff on all shifts were in-serviced. On 10/23/2024, in-services continued about corporate compliance, social media, resident's rights, abuse and Health Insurance Portability and Accountability Act (HIPPA).

During a telephone interview on 01/23/2025 at 9:46 AM, the Administrator stated on 10/23/2024, the Director of Nursing informed them about a TikTok social media posting involving Resident #4 and Certified Nursing Assistant #3. They stated Certified Nursing Assistant #3 admitted to posting the TikTok video as they wanted to show the life of a Certified Nursing Assistant. The Administrator stated Certified Nursing Assistant #3 stated they knew they should not have posted the video. The Administrator stated even though there were no harm done to Resident #4, Certified Nursing Assistant #3 was terminated. Administrator stated it is documented in the abuse policy and in the employee handbook that posting videos of residents on social media was not allowed without resident's consent. The Administrator stated to prevent reoccurrence, an immediate in-service was conducted regarding social media and the abuse policy. The policy was updated to include that videos and pictures of residents should not be posted on social media.

The facility Past Noncompliance was identified on 01/10/2025.

The facility was back in compliance as of 10/23/2024.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 2 of 3 335416 Department of Health & Human Services Printed: 09/10/2025 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 335416 B. Wing 01/27/2025

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

Dry Harbor Nursing Home 61 35 Dry Harbor Road Middle Village, NY 11379

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 0583 Based on the following corrective action taken, there was sufficient evidence that the facility corrected the Past Noncompliance and was in substantial compliance for this specific regulatory requirement prior to Level of Harm - Minimal harm or surveyor's on site visit on 01/10/2025. potential for actual harm

The facility implemented the following corrective actions prior to surveyor entrance on 01/10/2025 at 9:00 AM. Residents Affected - Few

After a facility's head of department meeting, Certified Nursing Assistant #3 was terminated on 10/22/2024.

The facility's Policy on Abuse and employee handbook was update to include social media postingis not allowed.

The Facility started in-service on 10/22/2024, 94% of all staff were in-serviced. The staff consisted of 62.2 % of Registered Nurses, 82 % of License Practical Nurses and 91.3% of Certified Nursing Assistants.

The Lesson plan included privacy, photos, videos, and social media in the setting of the nursing home and pertaining to residents.

An emergency Quality Assurance and Performance Improvement meeting was conducted 10/22/2024 to address the Tik Tok social media post and to report the incident to the New York State Department of Health.

The Compliance Committee meeting dated 11/06/2024 was held and there were no further issues.

The Social Media Audits conducted on Facebook, Instagram and Tik Tok were done weekly and there were no further posting seen.

During an interview on 01/10/2025, 14 staff members including License Practical Nurses, Physical Therapist, Certified Nursing Assistants, Registered Nurses, Housekeeping, and Recreation staff stated they received in-services on social media. They understood resident's privacy and rights and that social media posting was not allowed.

There were no further concerns.

10 NYCRR 415.3 (d)(1)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 3 of 3 335416