Inspection Reports for Springvale Nursing and Rehabilitation Center

The facility was found deficient in multiple areas including failure to notify resident representatives of changes in condition, inadequate protection of resident property, failure to timely report abuse allegations, inconsistent assistance with activities of daily living, lapses in infection prevention and control practices, and malfunctioning call bell system on Unit 2 East.

The facility was found deficient in multiple areas including failure to notify resident representatives of changes in condition, inadequate protection of resident property, failure to timely report alleged abuse, inaccurate resident assessments, incomplete care plans, inconsistent assistance with activities of daily living, lack of emergency respiratory equipment, improper medication storage and labeling, failure to provide special eating utensils, food safety violations, ineffective infection control practices, pest control deficiencies, and untrained feeding assistants.

Inspection found multiple Level 2 standard health deficiencies related to quality of care and life safety code deficiencies including cooking facilities and corridor doors. No actual harm but potential for more than minimal harm.

The abbreviated survey was complaint-driven, investigating allegations of failure to notify family of significant changes, abuse incidents involving residents #5 and #7, and failure to provide psychiatric consultation after abuse allegations. Substantiation status is not explicitly stated.

The facility failed to notify a resident's representative of a significant change in condition, did not ensure residents remained free from abuse, failed to timely report suspected abuse, and did not provide appropriate psychiatric consultation following abuse allegations. Several residents experienced harm or potential harm due to these deficiencies.

Multiple Level 2 standard health deficiencies related to abuse prevention, notification of changes, quality of care, and reporting of alleged violations. All deficiencies were corrected by May 22, 2025.

The visit was complaint-related, triggered by allegations of resident-to-resident abuse involving Residents #1, #2, #3, and #4. The investigations concluded there was no cause to believe any alleged resident abuse or mistreatment had occurred, but the facility failed to timely submit required reports and update care plans accordingly.

The facility failed to ensure residents' right to be free from abuse in four residents involved in multiple resident-to-resident altercations. Investigations concluded no intentional abuse occurred, but care plans were not updated to reflect incidents. Additionally, the facility failed to timely submit investigative reports to the New York State Department of Health within 5 working days as required.

Level 2 deficiencies in care plan timing and revision, abuse prevention, and reporting of alleged violations. Deficiencies showed pattern scope and were corrected by March 7, 2025.

The facility failed to ensure that their facility assessment included an evaluation of the overall number of staff needed to meet residents' needs. The staffing plan documented nursing levels based on an average daily census of 185 but did not specify minimum staffing numbers or include Home Health Aides in the assessment.

One Level 2 deficiency related to facility assessment, corrected by January 17, 2025.

The facility failed to ensure comprehensive discharge care plans with measurable objectives and timely interdisciplinary meetings for residents discharged in April 2024. Additionally, the facility did not maintain a safe environment free from accident hazards and failed to update fall risk care plans or implement timely interventions after multiple falls for a high-risk resident.

Level 2 deficiencies in comprehensive care plan development and accident hazard prevention, corrected by August 23, 2024.

The facility failed to develop and implement a baseline care plan within 48 hours for a newly admitted resident, did not clarify conflicting hospital discharge orders for insulin and blood glucose monitoring, and lacked sufficient licensed nursing staff on one unit during a medical emergency involving the resident.

Level 2 deficiencies in baseline care plan, quality of care, and sufficient nursing staff, all corrected by April 11, 2024.

The visit was complaint-related, triggered by an incident where Resident #3 fell out of bed due to inadequate supervision by CNA #1. The investigation concluded no abuse or neglect occurred, but the deficiency was substantiated as a failure to provide adequate supervision.

The facility failed to ensure adequate supervision of Resident #3, who fell out of bed and sustained a fracture. The investigation found that CNA #1 left the resident unattended while obtaining supplies, despite prior education on safety and accident prevention. The facility had policies on accident hazards and fall prevention, and staff were educated on safety, but the incident occurred due to failure to follow these protocols. CNA #1 was suspended and re-educated, and the care plan was updated to include fall risk interventions.

One Level 2 deficiency related to accident hazards, corrected by September 6, 2023.

The facility was found deficient in timely reporting of suspected abuse, implementation of care plans, nutritional care, infection control practices, call system accessibility, and maintaining a safe and clean environment. Specific issues included delayed reporting of an injury of unknown origin, failure to provide assistive devices as ordered, unaddressed significant weight loss, improper management of an indwelling catheter bag, inaccessible call bells in resident bathrooms, and unsanitary conditions in a resident's room.

The facility failed to report an injury of unknown origin involving Resident #94 to the New York State Department of Health within the required two-hour timeframe. Resident #94 sustained a fracture to the left humerus, but the incident was reported four days late. Interviews with the Director of Nursing and Administrator confirmed the reporting delay.

Multiple Level 2 deficiencies related to comprehensive care plan, infection control, nutrition, reporting, resident call system, environment, and life safety code issues including cooking facilities, corridor doors, egress doors, electrical equipment, fire alarm system, sprinkler system, and evacuation plans. All corrected by August-September 2023.

One Level 2 deficiency related to reporting to national health safety network, widespread scope, no correction noted.

One Level 2 deficiency related to accident hazards, corrected by July 1, 2022.

The survey found deficiencies including failure to ensure resident dignity during interviews and meal assistance, inadequate advanced directives documentation and communication, improper food labeling and unsanitary conditions in refrigerators, and lapses in infection prevention practices such as failure to clean pulse oximeters and perform hand hygiene between resident contacts.