Inspection Reports for
Greenfield Health & Rehab Center
5949 Broadway, Lancaster, NY, 14086
Back to Facility ProfileCitations (last 3 years)
Citations (over 3 years)
12.7 citations/year
Citations are regulatory findings recorded during state inspections.
149% worse than New York average
New York average: 5.1 citations/yearCitations per year
20
15
10
5
0
Inspection Report
Routine
Citations: 4
Date: Aug 8, 2025
Visit Reason
The inspection was a standard routine survey conducted to assess compliance with regulatory requirements related to medication use, catheter care, intravenous therapy, and resident rights.
Findings
The facility was found deficient in ensuring residents were free from unnecessary psychotropic medications, providing appropriate catheter care including use of leg bags, administering intravenous antibiotics timely and maintaining central venous catheter care, and properly informing residents about binding arbitration agreements with correct rescission periods.
Citations (4)
F 0605: The facility increased Resident #157's Xanax dose without documented clinical indication or medical provider order, resulting in unnecessary psychotropic medication use.
F 0690: Resident #113 with an indwelling catheter was not consistently provided a urinary leg bag as preferred, and catheter drainage tubing was observed touching the floor, posing infection control risks.
F 0694: Resident #174 did not receive intravenous antibiotics timely per hospital discharge orders, and there were no physician orders for central venous catheter maintenance, causing delays and risk of catheter occlusion.
F 0847: The facility's Binding Arbitration Agreement allowed only seven days for residents to rescind the agreement, contrary to regulatory requirements for a 30-day rescission period.
Report Facts
Residents reviewed for psychotropic medication: 5
Residents reviewed for catheter care: 3
Resident reviewed for IV therapy: 1
Days delay in IV antibiotic administration: 2
Days allowed to rescind arbitration agreement per facility: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Physician Assistant #2 | Psychiatry Physician Assistant | Named in medication error finding related to Resident #157's Xanax dosage increase. |
| Nurse Practitioner #1 | Nurse Practitioner | Named in medication error finding and IV therapy deficiency related to Resident #157 and Resident #174. |
| Registered Nurse #9 | Unit Manager | Named in medication error finding related to transcription error of Resident #157's Xanax order. |
| Director of Nursing | Director of Nursing | Provided statements regarding medication and catheter care deficiencies. |
| Pharmacy Consultant | Pharmacy Consultant | Participated in review of psychotropic medication and IV therapy deficiencies. |
| Director of Admissions | Director of Admissions | Named in arbitration agreement deficiency related to rescission period explanation. |
| Licensed Practical Nurse #4 | Nursing Supervisor | Initiated maintenance orders for Resident #174's central venous catheter. |
Inspection Report
Complaint Investigation
Capacity: 60
Citations: 11
Date: Aug 8, 2025
Visit Reason
Inspection identified 7 standard health citations and 4 life safety code citations, including issues with bowel/bladder incontinence, infection control, and fire alarm system maintenance.
Findings
Inspection identified 7 standard health citations and 4 life safety code citations, including issues with bowel/bladder incontinence, infection control, and fire alarm system maintenance.
Citations (11)
Bowel/bladder incontinence, catheter, uti
Department criminal history review
Entering into binding arbitration agreements
Infection control
Parenteral/iv fluids
Responsibilities of providers; required notif
Right to be free from chemical restraints
Fire alarm system - testing and maintenance
Hvac
Means of egress - general
Soiled linen and trash containers
Inspection Report
Complaint Investigation
Capacity: 60
Citations: 16
Date: Dec 18, 2023
Visit Reason
Complaint survey with 7 standard health citations and 9 life safety code citations, including antibiotic stewardship, abuse prevention, infection control, privacy, and multiple life safety code issues corrected by early 2024.
Findings
Complaint survey with 7 standard health citations and 9 life safety code citations, including antibiotic stewardship, abuse prevention, infection control, privacy, and multiple life safety code issues corrected by early 2024.
Citations (16)
Antibiotic stewardship program
Free from abuse and neglect
Free of accident hazards/supervision/devices
Infection prevention & control
Personal privacy/confidentiality of records
Responsibilities of providers; required notif
Right to be free from physical restraints
Cooking facilities
Corridor - doors
Electrical systems - essential electric syste
Fire drills
Gas equipment - cylinder and container storag
Hazardous areas - enclosure
Means of egress - general
Soiled linen and trash containers
Sprinkler system - maintenance and testing
Inspection Report
Complaint Investigation
Capacity: 60
Citations: 1
Date: Jan 18, 2023
Visit Reason
Complaint survey with one standard health citation for investigating and preventing alleged violations, corrected by February 2023.
Findings
Complaint survey with one standard health citation for investigating and preventing alleged violations, corrected by February 2023.
Citations (1)
Investigate/prevent/correct alleged violation
Inspection Report
Complaint Investigation
Capacity: 60
Citations: 2
Date: Jan 3, 2023
Visit Reason
Complaint survey with two standard health citations including a Level 4 immediate jeopardy for CPR and a Level 2 for notification of changes, both corrected by February 2023.
Findings
Complaint survey with two standard health citations including a Level 4 immediate jeopardy for CPR and a Level 2 for notification of changes, both corrected by February 2023.
Citations (2)
Cardio-pulmonary resuscitation (cpr)
Notify of changes (injury/decline/room, etc.)
Inspection Report
Complaint Investigation
Capacity: 60
Citations: 4
Date: May 31, 2022
Visit Reason
Complaint survey with several standard health citations including criminal history checks, infection control, and reporting of alleged violations, mostly corrected by mid-2022.
Findings
Complaint survey with several standard health citations including criminal history checks, infection control, and reporting of alleged violations, mostly corrected by mid-2022.
Citations (4)
Criminal history record check process
Department criminal history review
Infection control
Reporting of alleged violations
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