Renaissance Rehabilitation And Nursing Care Center

F 0677

Provide care and assistance to perform activities of daily living for any resident who is unable.

Level of Harm - Minimal harm or potential for actual harm

Based on observations, record review, and interviews conducted during an Abbreviated Survey (2579539),

the facility did not ensure that residents who were unable to carry out activities of daily living received the necessary services to maintain personal hygiene for one (1) of three (3) residents reviewed for activities of daily living. Specifically, Resident #3 was dependent on staff assistance for bathing and did not consistently receive showers twice per week per the resident's care plan and preference. The findings include: The policy and procedures on Activities of Daily Living/Maintain Abilities, revised 09/11/2024, stated that the facility was responsible for creating an environment that individualized each resident's quality of life. Staff across all shifts and departments were expected to understand and support principles of quality of life and honor each resident's preferences, choices, values, and beliefs. The facility also ensured residents were given appropriate treatment and services to maintain or improve their ability to perform activities of daily living. Resident #3 was admitted with diagnoses including cerebrovascular disease, dysarthria, and asthma. The admission Minimum Data Set assessment, dated 01/23/2025, documented the resident had intact cognition. For preferences for customary routine and activities, it was documented as very important for Resident #3 to choose between a tub bath, shower, bed bath, or sponge bath. Resident #3 was dependent on staff to complete bathing, and transfers for bathing and showering. The comprehensive care plan for activities of daily living dated 01/20/2025 documented interventions to provide showers twice per week as per the resident's preference. The 7/31/2025 Resident Nursing Instructions (care instructions for direct care staff) documented to shower on Tuesday and Friday evenings (initiated 01/24/2025). The July 2025 Certified Nurse Aide accountability documentation for the 3PM to 11PM shift, documented the resident received 5 of 9 showers for the month. The August 2025 Certified Nurse Aide accountability documentation for the 3PM to 11PM shift, documented the resident received 3 showers for the month.

During an observation on 10/29/2025 at 11:50 AM, the resident was in bed not wearing a shirt and wearing

an adult brief as the sheet was off the resident's body. The resident was interviewed during the observation and stated they did not always get showers when they should. During an interview on 10/30/2025 at 9:10 AM, the Staff Development Licensed Practical Nurse stated the resident usually told the staff when they wanted their shower, and the resident did not refuse their showers. During an interview on 10/30/2025 at 1:57 PM, Certified Nurse Aide #2 stated there was a time when the resident reported they did not receive a shower on the 3 PM-11 PM shift. During an interview on 10/30/2025 at 2:32 PM, the Director of Nursing stated they observed a pattern on the 3-11 and 11-7 shifts in which the Certified Nurse Aides were not documenting the care provided. The Director of Nursing stated the supervisor should review the Kiosk to confirm that documentation was completed. 10 NYCRR 415.12 (a)(3)

Residents Affected - Few

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:

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

11/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Renaissance Rehabilitation and Nursing Care Center

4975 Albany Post Road Staatsburg, NY 12580

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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

nostril. The resident was assisted off the floor and transferred to bed with staff assistance of two persons.

The physician and family were notified at 6:00 PM. Follow up for 72 hours and observe for signs and symptoms of injury such as ecchymosis, pain, swelling and a change in mentation or behavior.

There was no documented evidence in the nursing progress notes from 07/19/2025 through 07/29/2025 that a registered nurse assessed Resident #4 prior to the resident being transferred from the floor to the bed.

There was no documented evidence that 72-hour post fall monitoring was conducted and/or treatment was put in place to address Resident #4's bloody nose.

The staffing dated 7/19/25, documented on the second floor Licensed Practical Nurse #12 worked 7 AM -7 PM, Licensed Practical Nurse #13 worked 7 AM to 2 PM and Licensed Practical Nurse#14 worked 7 PM -11PM. Licensed Practical Nurse Supervisor #8 worked 7 PM on 7/19/25 to 7 AM on 7/20/25. There were no Registered Nurses scheduled to work from 7 AM on 7/19/25 until 7 AM on 7/20/25. During this time Resident#4 was found on the floor in their room on 7/19/25 at 6 PM with a bloody nose.

During an interview on 11/6/25 at 10:20AM, Certified Nurse Aide #11 stated they found the resident on the floor. They stated they knew they could not move the resident and told Licensed Practical Nurse #12. They stated the resident was transferred back to bed by Licensed Practical Nurse #12 and Licensed Practical Nurse #8. They stated there were no other nurses that came to see the resident.

During an interview on 10/30/25 at 11:55AM, Licensed Practical Nurse #12 stated the process was to call

the Director of Nursing. Licensed Practical Nurse #12 stated they did not recall speaking with the director of nursing regarding Resident #4's fall. They stated they often communicated with the Director of Nursing via text. They stated they had not seen the Director of Nursing come to the facility to assess residents after fall/s.

During an interview on 10/30/25 at 11:31AM, Licensed Practical Nurse Supervisor #8 stated they were working at the time of Resident #4's fall. They stated the process was to call the Director of Nursing, the Medical Director, and corporate nurse if there was a fall in the building after hours. They stated many times there were no registered nurses working at the facility when residents had falls. They stated they did not remember a registered nurse being in the building to conduct an assessment at the time of Resident #4's fall.

During an interview on 10/29/2025 at 11:38AM, the Director of Nursing stated they were the backup when there were no registered nurses in the building. They stated they did not come to the facility to assess residents, instead the nurses called them with problems, and they provide guidance and support over the phone. They stated they did not write notes after speaking to nurses about incidents. They stated they were not aware of Resident #4's 07/19/2025 fall until 07/21/2025. They stated they had an in-service with the nurses to remind them they needed to call them about falls in the facility.

During a follow up interview on 10/30/2025 at 12:56 PM the Director of Nursing stated they now remembered being notified by the nurse about the fall. They stated they did not write a note or an assessment because they had a lot of things on their mind. 10NYCRR 415.12

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

11/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Renaissance Rehabilitation and Nursing Care Center

4975 Albany Post Road Staatsburg, NY 12580

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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

during the interview, the Director of Nursing stated a root cause analysis was not completed for the accident/incident. They stated a root cause analysis should have been completed by the Director of Nursing or other facility staff. During a follow-up telephone interview on 11/19/2025 at 1:30 PM, the Director of Nursing stated they not informed of the accident on 04/12/2025 and should have been as there was no Registered Nurse in the building on 04/12/2025. The Director of Nursing stated they reviewed the Accident and Incident Report on 04/14/2025. They stated they did not complete a root cause analysis or investigation including the circumstances leading up to Resident #7 being burned or location of where the burn occurred.

The Director of Nursing stated residents received hot fluids with their meal trays and could also request hot fluids from staff during other times. They stated the kitchen staff monitored the temperature of hot fluids delivered to units and the unit staff did not check temperatures. Thick cups were used for hot beverages with plastic covers which should be used all the time. They stated that if staff observed a resident ambulating or propelling in their wheelchair with an uncovered hot liquid, staff would assist the resident and by carrying the cup or obtaining a lid. During the interview, the Director of Nursing reviewed the electronic medical records and stated the only intervention put in place after the 04/12/2025 accident was resident education. They could not locate any further interventions to prevent reoccurrence. They stated they were aware that a recommendation was made by Registered Dietician to include a lid with beverages for Resident #7 and that the recommendation was not entered into the Resident care plans or the Certified Nurse Aide task records until 10/29/2025. The Director of Nursing stated facility staff, including dietary, nursing and management discussed the lid use recommendation during morning report after the incident.

They were not aware how this intervention would have been discussed with Certified Nurse Aide staff since

it was not added to their tasks by nursing until 10/29/2025 (five months after the first burn and 2 months

after the second burn). They were unaware why a portable cup with lid was not put in place after the 04/12/2025 accident. The Director of Nursing stated they or the Administrator would be responsible for informing the Department of Health of resident burn. They stated the Department of Health should have been notified and were unaware why the notification did not occur. During an interview with Licensed Practical Nurse #15 on 11/19/2025 at 2:32 PM they stated they recalled being notified by unit staff on 04/12/2025 that Resident #7 had blisters on left upper thigh. They stated they spoke to Resident #7 who stated they had spilled hot cocoa on the evening of 04/11/2025. Licensed Practical Nurse #15 stated they notified the Nurse Practitioner by phone and received orders for treatment. They did not recall if there was a Registered Nurse in the building on 04/12/2025 or if they contacted the Director of Nursing. They stated

they were not aware of any interventions that were put in place after the incident to prevent reoccurrence.

They stated staff monitored for lids during tray pass and in the dining room. If a resident was observed in

the hallway carrying hot fluids, they would be redirected to sit and complete the hot liquid or the Certified Nurse Aide would carry the hot fluid to the resident's room. They stated they were not aware of the supervision needs for Resident #7 who was very independent.10NYCR 483.25 (d)(1)(2)

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

11/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Renaissance Rehabilitation and Nursing Care Center

4975 Albany Post Road Staatsburg, NY 12580

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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

pass with the family. During an observation on 10/29/2025 at 11:50 AM, the resident was in bed not wearing any shirt and wearing an adult brief as the sheet was off the resident's body. The resident was interviewed during the observation they stated when they needed help, they yelled for staff to assist by calling, nurse! nurse! Staff did not answer, and they would be incontinent. They did not like wearing the brief and would like to be assisted to the toilet. They stated that when they went to visit their family, they did not wear adult briefs and used the toilet. The resident stated the staff were aware of their preference to be assisted to the toilet; they had told the certified nurse aides and nurses, but they did not listen to them.

During an interview on 10/30/2025 at 1:08 PM, Certified Nurse Aide #2 stated that the resident transferred with two assistants, could stand and was capable of being toileted. They also stated at times they did not have the staff to assist the resident. During an interview on 10/30/2025 at 1:27 PM, Registered Nurse #6 stated that the resident had not been on a toileting program. During an interview on 10/30/2025 at 1:57 PM,

the Director of Rehabilitation stated that the resident could request to sit on the toilet and that the rehab team did not recommend that the resident not be toileted. They stated toileting schedules were the responsibility of nursing to implement. During an interview on 10/30/2025 at 2:12 PM, the Nurse Practitioner stated that if the resident was aware of when they needed to go to the bathroom, then the resident should be trialed with voiding and could use a bedside commode. The Nurse Practitioner also stated that they did not know the resident's full capacity but would have physical therapy re-evaluate the resident for toileting need. During an interview on 10/30/2025 at 2:32 PM, the Director of Nursing stated Resident #3 was not on a voiding program and the resident was not a candidate for a voiding program because they require two assistants for transfers. 10 NYCRR 415.12 (d)(2)

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

11/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Renaissance Rehabilitation and Nursing Care Center

4975 Albany Post Road Staatsburg, NY 12580

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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

answer call bells, and find help for transfers requiring a mechanical lift. During a follow up interview on 10/30/25 at 10:30 AM, Certified Nurse Aide#3 stated there were only three Certified Nurse Aides working

on the unit. The plan was to work with the other Certified Nurse Aide to get residents ready for the day. At

this time, they were still getting residents out of bed and making the toileting changes that were started at 7:00 AM. They stated they had eight (8) residents that required a mechanical lift for transfers and one (1) or two (2) more showers to give.During an interview on 10/30/25 at 10:36AM, Registered Nurse#6 stated they were giving meds on two sides today. They stated they were also assisting the Certified Nurse Aides as there were three (3) working. They stated they were constantly stopped and asked for help to get residents out of bed or to help with turning. They stated they could not get the medications passed out in a timely manner and residents got their medications late. They stated they were unable to get assessments done and care plans were often left incomplete. They stated some days there was only one Certified Nurse Aide.During an interview on 10/29/25 at 11:21 PM the Staffing Coordinator stated they did not have the staff to meet the staffing goals. They tried agency staffing but it was not a reliable source, and agencies did not have the structure or disciplinary model. They stated staffing was a challenge and they got help and direction from the Director of Nursing. They staffed units by need and not census and were aware there were days when they were below the minimum. The facility has offered incentives to get staff to work. They stated the evening shift has a lot of day workers working doubles. They are constantly working on recruitment but felt the surrounding areas are concentrated with nursing homes.During an interview on 10/29/25 at 11:38AM the Director of Nursing stated they were working with the Staffing Coordinator to get extra staff in the building, but it was difficult. They stated they came in on off hours to help out. Recruitment was ongoing and the Administration was aware of the problem. The staff in the building knew they needed to prioritize their work to get all tasks done. They stated four (4) Certified Nurse Aides should be enough to get things done.During an interview on 10/28/25 at 2:15PM, the Corporate Administrator stated they were

the Administrator at the facility until June 2025. At that time another corporate staff was helping with administrative tasks such as the Facility Assessment and kept it current. The Facility assessment dated [DATE REDACTED] was the current working document and was used to drive all activities and minimal staffing needed to care for all residents. They stated the Facility Assessment was an important document and someone should have gone over this with the new administrator.During an interview on 10/30/25 at 1:55 PM, the Administrator stated they were aware there was staffing problems but did not know the role of the Facility Assessment as a tool used to determine the number of staff needed. They stated the facility was recruiting. 10NYCRR 415.13(a)(1)(i-iii)

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

11/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Renaissance Rehabilitation and Nursing Care Center

4975 Albany Post Road Staatsburg, NY 12580

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 0727

415.13(b)(1)

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

11/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Renaissance Rehabilitation and Nursing Care Center

4975 Albany Post Road Staatsburg, NY 12580

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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

insurance approval and were unaware the medication would not have been delivered to the facility. The Director of Nursing stated they had not obtained prior approval in the past and thought it was the pharmacy's responsibility.During an interview with on 10/29/2025 at 12:03PM, the Nurse Practitioner stated if a medication was unavailable, they would expect either the nurse or the pharmacy to notify them. They were away in October during this time so they would have expected a medical provider would have been called.During an interview on 10/29/2025 at 2:15 PM, the physician stated they were made aware the resident did not get eszopiclone as ordered after six (6) doses were missed. They stated if they had been notified when the medication ran out, they could have ordered the resident an alternative sleep medication.

During an interview on 10/30/2025 at 1:45 PM, the pharmacy representative stated the Director of Nursing notified them the resident had not received eszopiclone from 10/11/2025-10/16/2025. They stated they thought the pharmacy had notified the facility that this medication required insurance authorization prior to

the medication being refilled and sent to the facility. The pharmacy representative was unsure who notified

the facility, or when the facility was notified. They stated the pharmacist obtained the authorization from the insurance company for the eszopiclone, so the medication could be sent to the facility.10NYRCC 415.18 (a)

Event ID:

Facility ID:

If continuation sheet