Inspection Reports for
Park Gardens Rehabilitation Center

The state logged 113 complaints about this facility; 7 led to on-site inspections.

Across 5 inspections, 24 citations were issued including 19 standard health and 5 life safety code citations. The facility had 113 complaints with 7 on-site inspections and 1 enforcement action recorded.

The complaint was substantiated based on interviews with Resident #19, their roommates, and CNA #1, as well as review of investigation records. CNA #1 was found to have taken money from Resident #19 and other residents previously, leading to suspension and eventual termination. Resident #19's insight and judgment were limited per psychiatric evaluation.

The facility failed to ensure Resident #19 was free from financial abuse, as CNA #1 with a history of misappropriation allegations took money from the resident. Despite prior corrective actions and termination of CNA #1, the investigation confirmed misappropriation occurred, and the resident was refunded. The resident had limited financial decision-making capacity according to a psychiatric consult.

The facility was found deficient in multiple areas including failure to provide residents or their representatives with a written summary of the Baseline Care Plan within 48 hours of admission, incomplete development and implementation of Comprehensive Care Plans (CCP) for residents' needs, failure to review and revise CCPs after assessments, and improper storage and documentation of controlled substances.

The facility was found deficient in multiple areas including failure to post survey results accessibly, poor maintenance of resident rooms and environment, inaccurate resident assessments, inadequate assistance with activities of daily living, improper medication labeling and storage, inaccurate medical record documentation, and lapses in infection control practices.

The complaint involved an allegation of verbal abuse by a physical therapist assistant (PTA) toward Resident #175. The resident reported the incident to staff and a grievance was initiated. The facility failed to report the allegation to NYSDOH within 24 hours and did not interview the resident or witnesses in a timely manner. The Director of Nursing concluded there was no evidence of abuse based on inconsistencies and resident history. The PTA was in-serviced but not removed from duty during the investigation.

The facility was found deficient in multiple areas including failure to provide residents with information on how to contact the Ombudsman and NYSDOH complaint line, failure to respect resident privacy during blood draws, failure to timely report and investigate an allegation of verbal abuse, incomplete care plans for resident activity preferences, improper medication management including expired and unlabeled medications, inadequate infection control practices by staff, and unsanitary conditions in a shared resident bathroom.