New Vanderbilt Rehabilitation And Care Center, Inc

F-F685 re: communication/maintaining hearing.

9. Refer to

F-F842 re: resident records.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 25 of 26 335372 Department of Health & Human Services Printed: 09/17/2025 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 335372 B. Wing 07/16/2024

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

New Vanderbilt Rehabilitation and Care Center, Inc 135 Vanderbilt Ave Staten Island, NY 10304

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 0865 14. Refer to

F-F865 re: QAPI.

Level of Harm - Minimal harm or 15. Refer to Resident R0610, Resident R0830, and Resident R1022 re: criminal history record check. potential for actual harm 16. Refer to I210 re: signage for COVID vaccine availability. Residents Affected - Some 16. Refer to

F-F880 re: repeat deficiencies.

On 07/16/24 at 4:05 PM, the Administrator was interviewed and stated when any deviation from expected performance, or a negative trend occurs the findings are brought to the attention of the Quality Assurance committee. Staff report quality concerns to the Quality Assurance committee through their chain of command, the compliance officer, or the hotline. The facility works on issues that trigger and issues that the department feels need improvements. Also, weekly rounds are done with the department heads and the findings are reported to the Quality Assurance and Performance Improvement Committee. The nursing team and department heads will give a report on whether the corrective actions are effective, and if improvement is occurring. Monthly Quality Assurance and Performance Improvement committee meetings have been implemented in order to fix the issues. They compare month to month from the monthly progress reports from the departments. They meet as a team and discuss the inputs and ideas on how to change and correct

the deficiencies. The Administrator stated at the time of the last survey, the facility submitted a plan of correction, and they continue to work on Quality Assurance and Performance Improvement and provide in-service training for the staff. The Administrator stated the facility performs competencies on staff and measure improvements and are working on recruiting staff with enticements such as bonuses. The Administrator stated the facility tracks performance by bringing it up to the team and move on if effective, if not effective then they continue to do Quality Assurance and Performance Improvement until compliance.

The Minimum Data Set assessments are being worked on and Abuse issues are being worked on also. The Administrator further stated the Director of Nursing is new at the facility and started a month ago and they took over as Administrator late last year.

10 NYCRR 415.27

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 26 of 26 335372