Pine Valley Center For Rehabilitation And Nursing
Inspection Findings
F-Tag F0609
F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Based on interview and record review conducted during the abbreviated survey (2626453), the facility did not ensure all alleged violations of abuse were reported immediately, but not later than two (2) hours to the New York State Department of Health for one (1) of three (3) residents reviewed for abuse (Resident #1).
Specifically, on 9/23/2025 at approximately 2:00 PM Resident #1's family member reported that Resident #1 alleged sexual abuse, and the allegation was not reported to the New York State Department of Health until 9/24/2025 at 11:18 AM. The 10/10/2024 facility policy titled Abuse Prevention Policy and Procedure, documented it is the responsibility of all facility employees, consultants, visitors, family members and physicians to immediately report any incident or suspected incident of resident abuse, neglect, mistreatment, exploitation, misappropriation of resident property or any resident injury of unknown origin.
All alleged violations involving abuse neglect exploitation or mistreatment including injuries of unknown origin and misappropriation of resident property must be reported immediately but no later than two hours
after the allegation is made, if the events that caused the allegation involve abuse or result in serious bodily injury or not later than 24 hours if the events that caused the allegation do not involve abuse and do not result in serious bodily injury to the administrator of the facility and to the New York State Department of Health. Resident #1 had diagnoses which included anxiety disorder, depression, and hypertension.The 7/15/25 Minimum Data Set Comprehensive admission Assessment documented the resident had intact cognition and physical and behavioral symptoms directed toward others which significantly intruded on the privacy or activity of others and put the resident at significant risk for physical illness or injury and significantly interfered with the resident's care. The resident required substantial assistance with showers/bathing.The 9/23/25 facility Incident Report documented that on 9/23/2025 at 2:00 PM, Resident #1's family member reported that Resident #1 made an allegation of sexual abuse. The Webform Submission Nursing Home Facility Incident Report documented the allegation of sexual abuse was submitted to the New York State Department of Health on 9/24/2025 at 11:18 AM. On 10/06/2025 at 10:34 AM during an interview, the Director of Nursing stated that on 9/23/2025 around 2:00 PM, the Director of Activities reported that Resident #1's family member reported Resident #1's allegation of sexual abuse. The Director of Nursing stated they did not report the allegation to the New York State Department of Health until 9/24/2025 at 11:18 AM because the allegation was vague and confusing, and the resident had a history of accusations, and the facility completed an internal investigation within two (2) hours and concluded that abuse did not occur. On 10/6/2025 at 2:10 PM during an interview, the facility Administrator stated they are aware that allegations of abuse should be reported within two (2) hours, however if the allegation is confusing or if the resident is confused, they want to do an internal investigation first to assure
the allegation needs to be reported to the New York State Department of Health, and if they believe abuse may have occurred they would report within two (2) hours. 10 NYCRR 415.4(b)(2)
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 REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility ID:
If continuation sheet
Event ID:
PINE VALLEY CENTER FOR REHABILITATION AND NURSING in SPRING VALLEY, NY inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in SPRING VALLEY, NY, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from PINE VALLEY CENTER FOR REHABILITATION AND NURSING or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.