Inspection Reports for
Sea Crest Nursing and Rehabilitation Center
3035 West 24th St, Brooklyn, NY, 11224
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Inspection Report — Aug 26, 2025
Annual Inspection CMS
Date: Aug 26, 2025
Visit Reason
The inspection was a Recertification survey to assess compliance with regulatory requirements for nursing home operations and resident care.
Findings
The facility was found deficient in updating a resident's comprehensive care plan to reflect changes in anticoagulant medication, posting accurate and complete daily nurse staffing information, and maintaining proper infection control practices during dining assistance.
Citations (3)
F 0657: The facility failed to update Resident #163's comprehensive care plan to reflect the discontinuation of Apixaban and initiation of Aspirin therapy for atrial fibrillation.
F 0732: The facility failed to post accurate and complete daily nurse staffing information, omitting total number and actual hours worked by licensed and unlicensed nursing staff per shift.
F 0812: The facility did not ensure infection control practices during dining assistance, as Certified Nursing Assistants failed to perform hand hygiene between assisting multiple residents.
Report Facts
Residents sampled: 38
Residents cited: 1
Residents affected: 5
Observation period: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Registered Nurse #1 | Registered Nurse | Interviewed regarding Resident #163's care plan update |
| Registered Nurse #2 | Registered Nurse | Interviewed regarding Resident #163's medication and care plan |
| Director of Nursing | Director of Nursing | Interviewed regarding responsibility for care plan updates and staffing postings |
| Staffing Coordinator | Staffing Coordinator | Interviewed regarding daily nurse staffing postings |
| Certified Nursing Assistant #5 | Certified Nursing Assistant | Observed and interviewed regarding hand hygiene during dining assistance |
| Certified Nursing Assistant #6 | Certified Nursing Assistant | Observed and interviewed regarding hand hygiene during dining assistance |
| Registered Nurse #6 | Registered Nurse | Interviewed regarding monitoring dining and infection control |
| Assistant Director of Nursing | Assistant Director of Nursing | Interviewed regarding infection control and hand hygiene policies |
| Infection Preventionist | Infection Preventionist | Interviewed regarding infection control audits and monitoring |
Inspection Report — Aug 26, 2025
State
Date: Aug 26, 2025
Visit Reason
State-compiled facility profile showing 7 inspections from June 2022 to May 2026 with citation and complaint history.
Complaint Details
The state logged 168 complaints about this facility; 7 led to on-site inspections. One citation resulted from those complaints.
Findings
Across 7 inspections, 4 resulted in 17 citations including standard health and Life Safety Code violations, mostly minor potential harm. The facility had 168 complaints with 7 on-site inspections and no formal enforcement actions.
Citations (15)
Care Plan Timing And Revision: Standard Health Citation — quality of care with minor potential harm.
Food Procurement,store/prepare/serve-sanitary: Standard Health Citation — quality of care with minor potential harm.
Posted Nurse Staffing Information: Standard Health Citation — quality of care with potential for minimal harm.
Electrical Systems - Essential Electric Syste: Life Safety Code Citation — NFPA requirements with minor potential harm.
Sprinkler System - Maintenance And Testing: Life Safety Code Citation — NFPA requirements with minor potential harm.
Reporting - National Health Safety Network: Standard Health Citation — quality of care with minor potential harm.
Free From Unnec Psychotropic Meds/prn Use: Standard Health Citation — quality of care with minor potential harm.
Infection Prevention & Control: Standard Health Citation — quality of care with minor potential harm.
Posted Nurse Staffing Information: Standard Health Citation — quality of care with potential for minimal harm.
Reporting Of Alleged Violations: Standard Health Citation — quality of care with minor potential harm.
Resident Rights/exercise Of Rights: Standard Health Citation — quality of care with minor potential harm.
Right To Be Free From Physical Restraints: Standard Health Citation — quality of care with minor potential harm.
Right To Survey Results/advocate Agency Info: Standard Health Citation — quality of care with minor potential harm.
Corridors - Construction Of Walls: Life Safety Code Citation — NFPA requirements with minor potential harm.
Reporting - National Health Safety Network: Standard Health Citation — quality of care with minor potential harm.
Report Facts
Inspections on page: 7
Total violations/deficiencies cited: 17
Inspections with violations: 4
Inspections without violations: 3
Total complaints: 168
On-site complaint inspections: 7
Citations from complaints: 1
Enforcement actions: 0
Inspection Report — Oct 10, 2023
Complaint Investigation CMS
Date: Oct 10, 2023
Visit Reason
The inspection was conducted based on recertification and complaint investigations regarding the facility's failure to timely report suspected abuse, neglect, or injury of unknown origin involving a resident.
Complaint Details
The complaint investigation found that the facility failed to report an injury of unknown origin involving Resident #478 who had a hematoma on the right side of their head. The incident was unwitnessed, and the resident could not recall what happened. The facility did not report the incident to the Department of Health in the Health Electronic Response Data System (HERDS) as required. The Director of Nursing and Assistant Director of Nursing confirmed the incident was not reported because they ruled out abuse, neglect, and mistreatment.
Findings
The facility failed to report an injury of unknown origin involving a resident who sustained a hematoma to the right side of their head. The investigation found that the incident was not reported to the State Survey Agency as required, despite facility policies mandating timely reporting of such incidents.
Citations (1)
F 0609: The facility did not timely report suspected abuse, neglect, or injury of unknown origin involving a resident who sustained a right frontotemporal scalp hematoma. The incident was not reported to the State Survey Agency as required by policy and regulations.
Report Facts
Residents reviewed: 38
Residents affected: 3
Residents affected: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Certified Nursing Assistant (CNA #10) | Left voicemail for survey exit but no return call | |
| Registered Nurse Supervisor (RN #4) | Interviewed regarding resident fall and reporting procedures | |
| Assistant Director of Nursing (ADNS) | Interviewed regarding incident reporting and review of Accident and Incident report | |
| Director of Nursing (DNS) | Interviewed regarding reporting requirements and incident classification | |
| Administrator | Interviewed regarding incident notification and reporting policies |
Inspection Report — Oct 10, 2023
Annual Inspection CMS
Date: Oct 10, 2023
Visit Reason
The inspection was a Recertification survey conducted from 10/2/23 to 10/10/23 to assess compliance with federal regulations for nursing homes.
Findings
The facility was found deficient in multiple areas including resident dignity and privacy, posting of survey results, use of physical restraints, timely reporting of suspected abuse, posting of nurse staffing information, use of unnecessary psychotropic medications, and infection control practices during wound care.
Citations (7)
F 0550: The facility failed to maintain resident dignity by not covering Foley catheter bags and exposing a resident's back and buttocks during transport in the hallway.
F 0577: The facility did not post notice of the availability of nursing home survey results in prominent and accessible areas for residents and visitors.
F 0604: The facility did not ensure physical restraints (hand mittens) were released every two hours as ordered for one resident.
F 0609: The facility failed to timely report an injury of unknown origin involving a resident's head hematoma to the State Survey Agency.
F 0732: The facility did not post daily nurse staffing information in a prominent place accessible to residents and visitors on multiple units.
F 0758: The facility did not ensure residents were free from unnecessary antipsychotic medications; one resident's psychotropic medication dose was increased without documented behavioral indications or nonpharmacological interventions.
F 0880: The facility failed to maintain infection control during wound care; a nurse did not perform hand hygiene after removing a soiled dressing and did not maintain aseptic technique while cleansing a wound.
Report Facts
Residents reviewed: 38
Residents reviewed for dignity: 2
Residents affected for dignity deficiency: 2
Units with missing nurse staffing posting: 7
Residents reviewed for physical restraints: 38
Residents affected by physical restraint deficiency: 1
Residents reviewed for unnecessary medications: 38
Residents affected by unnecessary medication deficiency: 1
Residents reviewed for pressure ulcer/injury: 5
Residents affected by infection control deficiency: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| RN #13 | Registered Nurse | Observed performing wound care with deficient infection control practices |
| CNA #1 | Certified Nursing Assistant | Interviewed regarding catheter care and privacy bag application |
| RN #1 | Registered Nurse | Interviewed regarding catheter bag privacy and CNA training |
| RN #2 | Registered Nurse, Charge Nurse | Interviewed regarding catheter bag privacy and CNA training |
| Director of Nursing | Director of Nursing | Interviewed regarding catheter bag privacy policy and restraint re-evaluation |
| CNA #8 | Certified Nursing Assistant | Observed and interviewed regarding resident exposure during transport |
| LPN #2 | Licensed Practical Nurse | Interviewed regarding resident coverage after shower |
| RN #10 | Registered Nurse | Interviewed regarding resident coverage and rounds |
| CNA #11 | Certified Nursing Assistant | Interviewed regarding restraint release schedule |
| Assistant Director of Nursing (ADNS) #1 | Assistant Director of Nursing | Interviewed regarding restraint use and re-evaluation |
| Minimum Data System Assessor (MDSA) | MDS Assessor | Interviewed regarding restraint re-evaluation responsibilities |
| MDS Coordinator (MDSC) | MDS Coordinator | Interviewed regarding restraint re-evaluation responsibilities |
| Certified Nursing Assistant (CNA #10) | Certified Nursing Assistant | Left voicemail regarding injury reporting |
| RN #4 | Registered Nurse Supervisor | Interviewed regarding injury incident and staffing posting |
| Staffing Coordinator | Staffing Coordinator | Interviewed regarding nurse staffing posting |
| RN #5 | Registered Nurse | Interviewed regarding resident behavior and medication |
| Nurse Practitioner (NP) #1 | Nurse Practitioner | Interviewed regarding resident behavior consultation |
| Nurse Practitioner (NP) #2 | Nurse Practitioner | Interviewed regarding medication prescription |
| RN #6 | Registered Nurse Supervisor | Interviewed regarding consult for resident behavior |
| Medical Director (MD) #1 | Medical Director | Interviewed regarding medication increase rationale |
| Psychiatrist (MD #2) | Psychiatrist | Interviewed regarding medication increase rationale |
| Assistant Director of Nursing (ADNS) #2 | Assistant Director of Nursing, Inservice Coordinator | Interviewed regarding wound care competency and education |
| Infection Preventionist (ICP) | Infection Preventionist | Interviewed regarding wound care observations and hand hygiene |
Inspection Report — Jul 23, 2021
CMS
Date: Jul 23, 2021
Visit Reason
The document is a statement of deficiencies and plan of correction for Sea Crest Nursing and Rehabilitation Center following a survey completed on July 23, 2021.
Findings
No health deficiencies were found during the survey.
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