Elderwood At Ticonderoga
Inspection Findings
F-Tag F0580
F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Licensed Practical Nurse #1 was told by night nurse the catheter was not being replaced because there was no order, and they thought it should not be replaced due to the trauma caused by resident pulling it out with balloon inflated. They stated they were not aware the physician was not called. They would have called
the on-call provider if resident had pulled the catheter out on their shift.Registered Nurse #4 was the nurse responsible for the care of Resident #1 at the time of the incident. On 8/05 2025 at 1:50 PM and 8/06/2025 at 11:50 AM, attempts to contact Registered Nurse #4 were unsuccessful.On 8/05/2025 at 3:52 PM, attempt to contact Medical Provider #1 was unsuccessful. 10 New York Codes Rule Regulations 415.3(e)(2)(ii)(b)
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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
08/20/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Elderwood at Ticonderoga
101 Adirondack Drive Ticonderoga, NY 12883
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-Tag F0690
F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
and they read it on the 24-hour report that is used for daily reporting of the unit. They stated that the resident did not complain of any discomfort throughout the day. Licensed Practical Nurse #1 stated that in any case that a resident pulled their Foley catheter out, staff should follow the physician's orders. They stated that if there were no orders, staff should be contact a physician and following their directions. They stated that they did not call the physician that day as the resident was not complaining of any discomfort.During an interview on 8/05/2025 at 3:36 PM, Licensed Practical Nurse #1 stated that residents with foley catheters had orders for routine care of the residents' indwelling catheter. They stated that the routine care of residents with indwelling catheters included cleaning the area of insertion of the catheter, making sure that the catheter is intact, and recording the color, consistency, and amount of urine. Licensed Practical Nurse #1 reviewed the residents' electronic chart and stated there were no orders from the physician for the residents' indwelling catheter.Attempt to interview Medical Provider #1 were unsuccessful. 10 New York Codes and Rules and Regulations 415.12
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ELDERWOOD AT TICONDEROGA in TICONDEROGA, 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 TICONDEROGA, 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 ELDERWOOD AT TICONDEROGA or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.