Northwoods Rehab And Nursing Center At Moravia

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

#32 not receiving their clonazepam as ordered and Resident #45 not receiving their intravenous antibiotic as ordered should have been investigated. They were not employed by the facility at the time of the incidents with Resident #32 or Resident #45. Incidents like this were reported to the Department of Health by the Administrator. They were not sure if this was reported to the Department of Health as they were not employed by the facility at the time. During an interview on 9/24/2025 at 2:20 PM, Physician #18 stated if intravenous antibiotics were not administered, they should be called. A provider should always be notified.

They do not recall Resident #32 as some time had passed. They did recall Resident #45. They expected Resident #45 to receive their intravenous antibiotic that was ordered for an infection to the finger that required a partial amputation. They were not notified the resident did not have their antibiotic administered.

If they were notified of a missed antibiotic dose, they would have changed the order to have it be given intramuscularly. If a resident did not receive intravenous antibiotics, it would be a significant medication error. If the nurse did not notify them and did not get an intramuscular order to have it replaced with, it would be neglect. Without the antibiotic the resident may have required additional amputation. During an

interview on 9/24/2025 at 3:20 PM, former Director of Nursing #6 stated Resident #45 had a finger amputation and arrived back at the facility with a peripherally inserted central catheter and intravenous antibiotics. Licensed practical nurses were not allowed to administer intravenous antibiotics and registered nurses performed all the care for peripherally inserted central catheters. When they found the medication administration was missing, they notified the physician, however they did not recall if they documented that.

They did not recall if other medication administration records for other residents in the facility were reviewed. They did not know if neglect was ruled out because they were not able to continue the investigation as it was taken over by the Administrator. They did not recall anything regarding Resident #32's clonazepam as some time had passed. They were not sure if Registered Nurse #16 had been reported to the state for falsification of documentation, but they should have been.During an interview on 9/25/2025 at 1:00 PM, the Administrator stated they had training on abuse and neglect. They were responsible for reporting certain specific cases of abuse and neglect to the Department of Health. They were the facility Administrator at the time of the medication errors with both Resident #45 and Resident #32. The investigation started with former Director of Nursing #6 and they took over. They were not sure what was done to ensure medications were not missed for other residents. They were not sure if the missed administrations was neglect, however it was a significant medication error. Significant medication errors were reported to the state; however, they did not report it as they were new to their roll and was going through a rough situation. In hindsight they would have done things differently. 10NYCRR 415.4(b)(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

11/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Northwoods Rehab and Nursing Center at Moravia

7 Keeler Avenue Moravia, NY 13118

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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

signed for, they should tell the supervisor and document in a progress note. During an interview on 9/24/2025 at 1:43 PM, Director of Nursing #2 stated only registered nurses administered intravenous antibiotics. If medications were not given the provider should be notified and then documented in a progress note. If it was noticed that a nurse did not administer medications to one resident, they looked at all medication administration records for all residents and medication blister packs to ensure medications were given to other residents. Failure to administer medications required an investigation to rule out neglect or abuse. They were not employed by the facility at the time of the incidents with Resident #32 or Resident #45. During an interview on 9/24/2025 at 2:20 PM, Physician #18 stated if intravenous antibiotics were not administered, they should be called. A provider should always be notified. They did not recall Resident #32 but recalled Resident #45. They expected Resident #45 to receive their ordered intravenous antibiotic for an infection to the finger that required a partial amputation. They were not notified the resident did not have their antibiotic administered. If they were notified of a missed antibiotic dose, they would change the order to have it administered intramuscularly. If a resident did not receive intravenous antibiotics, it would be a significant medication error. Without the antibiotic the resident may have required additional amputation.

During an interview on 9/24/2025 at 3:20 PM, former Director of Nursing #6 stated Resident #45 had a finger amputation and arrived back at the facility with a peripherally inserted central catheter (venous access) and intravenous antibiotics. Licensed practical nurses were not allowed to administer intravenous antibiotics and registered nurses performed all the care for peripherally inserted central catheters. When

they found the medication administration was missing, they notified the physician, however they did not recall if they documented that. They did not recall if other medication administration records for other residents in the facility were reviewed. They did not recall anything regarding Resident #32's clonazepam as some time had passed. They were not sure if Registered Nurse #16 was reported to the state for falsification of documentation, but they should have been.An attempt to contact Registered Nurse #16 on 09/25/2025 at 3:43 PM was unsuccessful. The number provided by the facility was no longer in service. 10NYCRR 415.12(m)(2)

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