Inspection Reports for Bedford Center for Nursing and Rehabilitation

The facility was found deficient in ensuring residents were treated with dignity and respect, specifically regarding privacy during insulin administration. Additionally, the facility failed to ensure treatment and care were provided according to physician orders, including lack of physician order for a blood sugar monitoring device. Controlled medications were not properly stored in a locked double cabinet in the Unit 2 medication room.

Inspection revealed multiple standard health and life safety code deficiencies related to quality of care, resident rights, and safety features; all corrected by May and April 2025.

The facility failed to thoroughly investigate the elopement incident and did not ensure adequate supervision to prevent elopement. Resident #1, identified at high risk for elopement and assigned a wander alert device, exited the building undetected despite alarms and monitoring protocols. The investigation did not determine how Resident #1 exited the unit undetected, and monitoring and documentation of the wander alert device were inadequate.

Inspection identified standard health deficiencies related to accident hazards and investigation of alleged violations; all corrected by August 2023.

The facility failed to ensure a resident's right to privacy and did not develop or revise a comprehensive person-centered care plan (CCP) to address a resident's behavior problem of refusing to wear clothes or gown while in bed. Resident #157 was observed exposed in bed wearing only an incontinent brief, and the CCP did not reflect this preference or behavior.

The complaint investigation (NY00308940) found that Resident #165 did not have a urology consultation scheduled in accordance with Medical Doctor Orders to address recurrent urinary tract infections, despite multiple orders and follow-ups. The resident left the facility against medical advice before the consult could be completed.

The facility failed to ensure that Resident #165, who was incontinent of bladder and had recurrent urinary tract infections, received appropriate treatment and services including timely scheduling of a urology consultation as ordered by the Medical Doctor. The resident left the facility against medical advice before the consult could be completed.

Inspection found multiple standard health and life safety code deficiencies including care planning, privacy, fire alarm systems, and building construction; all corrected by May 2023.

The facility was found deficient in providing adequate activities to meet residents' needs, proper medication storage including removal of expired medications, food service hand hygiene, and infection control protocols including PPE use and hand hygiene by phlebotomy staff.