Inspection Reports for
St. Camillus Residential Health Care Facility
813 Fay Rd, Syracuse, NY 13219, USA, NY, 13219
Back to Facility ProfileDeficiencies (last 7 years)
Deficiencies (over 7 years)
9.7 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
90% worse than New York average
New York average: 5.1 deficiencies/yearDeficiencies per year
80
60
40
20
0
Occupancy
Latest occupancy rate
85% occupied
Based on a November 2023 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Occupancy rate over time
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: May 21, 2024
Visit Reason
The purpose of this visit was to conduct a compliance inspection and investigate intake #GA002465400.
Complaint Details
Investigation of intake #GA002465400 with no rule violations found.
Findings
No rule violations were cited as a result of this inspection/investigation.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Apr 8, 2024
Visit Reason
The purpose of this visit was to investigate intakes #GA00245507, #GA00245471, and #GA00244776.
Complaint Details
Investigation of three intakes was conducted with no rule violations found.
Findings
No rule violations were cited as a result of this investigation.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Mar 26, 2024
Visit Reason
The purpose of this offsite/desk review was to investigate Intake #GA00244007.
Complaint Details
Investigation of Intake #GA00244007 with no rule violations found.
Findings
No rule violations were cited as a result of this review.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Feb 15, 2024
Visit Reason
The purpose of this visit was to investigate intake #GA00242624.
Complaint Details
Investigation of intake #GA00242624 with no rule violations found.
Findings
No rule violation was cited as a result of this investigation.
Inspection Report
Abbreviated Survey
Deficiencies: 1
Date: Jan 22, 2024
Visit Reason
The abbreviated survey was conducted to assess compliance with safety and supervision regulations following an incident involving a resident accessing medications from an unlocked medication cart.
Findings
The facility failed to ensure adequate supervision and a safe environment for one resident who accessed and ingested medications from an unlocked medication cart, resulting in actual harm requiring hospitalization. The medication cart lock malfunctioned, and staff failed to ensure it was locked at all times.
Deficiencies (1)
F 0689: The facility did not ensure each resident received adequate supervision and the environment was free from accident hazards. Resident #2 accessed and ingested medications from an unlocked medication cart, resulting in actual harm requiring hospitalization.
Report Facts
Residents affected: 3
Medication bottles missing: 3
Date of survey completion: Jan 22, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse #3 | Named in medication cart lock incident and investigation | |
| Registered Nurse Manager #2 | Completed incident report and conducted investigation | |
| Nurse Practitioner #1 | Provided progress notes and telephone interview regarding the incident | |
| Licensed Practical Nurse Assistant Manager #5 | Alerted to resident accessing medication cart and intervened | |
| Director of Nursing | Interviewed regarding medication cart lock and incident response |
Inspection Report
Complaint Investigation
Capacity: 60
Deficiencies: 1
Date: Jan 22, 2024
Visit Reason
One isolated Level 3 deficiency related to accident hazards and supervision causing actual harm.
Findings
One isolated Level 3 deficiency related to accident hazards and supervision causing actual harm.
Deficiencies (1)
Free of accident hazards/supervision/devices
Inspection Report
Annual Inspection
Capacity: 284
Deficiencies: 9
Date: Nov 20, 2023
Visit Reason
The inspection was a recertification and abbreviated survey conducted to assess compliance with regulatory requirements for nursing home care.
Findings
The facility was found deficient in multiple areas including resident environment, care planning, activities of daily living assistance, treatment and wound care, staffing adequacy, food service quality, adaptive eating equipment, food safety, and call system accessibility.
Deficiencies (9)
F 0584: The facility failed to ensure a safe, clean, comfortable, and homelike environment; mattresses and furniture were in disrepair, meals were served directly on trays, and medication rooms and kitchenettes were unclean.
F 0656: The facility did not develop and implement comprehensive care plans meeting residents' medical, nursing, and psychosocial needs for 4 of 5 residents reviewed, including missing isolation precautions, failure to implement ordered treatments, and incorrect pressure mattress settings.
F 0677: The facility failed to provide necessary assistance with activities of daily living including grooming, personal hygiene, oral hygiene, and shaving for 5 of 7 residents reviewed.
F 0684: The facility did not ensure treatments and wound care were provided as ordered for a resident with unstageable pressure ulcers; treatments were not documented as completed on multiple dates.
F 0725: The facility failed to provide sufficient nursing staff to meet residents' needs, resulting in delayed call bell responses, missed personal care, and inadequate supervision.
F 0804: The facility did not ensure food was palatable, flavorful, accurate, and served at safe and appetizing temperatures; meal trays were missing items and some food was served cold or burned.
F 0810: The facility failed to provide special eating equipment as ordered for residents requiring adaptive devices, including scoop plates and built-up silverware.
F 0812: The facility did not ensure food was stored and prepared in accordance with professional standards; single service items were re-used, hood filters were damaged, and ice scoop was improperly stored.
F 0919: The facility failed to ensure resident call systems were accessible; a resident's call bell was repeatedly observed out of reach on the floor under the bed.
Report Facts
Licensed Capacity: 284
Residents on units: 241
Staffing counts: 3
Wound size: 6
Wound size: 7.5
Wound size: 5
Wound size: 5.5
Meal temperatures: 91
Meal temperatures: 141
Meal temperatures: 70
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN #21 | Licensed Practical Nurse | Mentioned in relation to observations about staffing, oral care, and wound treatment documentation. |
| LPN #24 | Licensed Practical Nurse | Mentioned regarding staffing shortages and care omissions. |
| RN Unit Manager #29 | Registered Nurse Unit Manager | Responsible for care plan oversight and staffing management. |
| LPN #48 | Licensed Practical Nurse | Documented medication administration but not wound treatment completion. |
| Chef Manager #62 | Chef Manager | Discussed food quality and meal tray checks. |
| CNA #40 | Certified Nurse Aide | Involved in incident regarding delayed incontinence care. |
| LPN #37 | Licensed Practical Nurse | Recalled incident of delayed incontinence care and staffing issues. |
| RN Supervisor #38 | Registered Nurse Supervisor | Responded to incident involving delayed incontinence care. |
| Dietitian #86 | Registered Dietitian | Discussed meal substitutions and dietary accommodations. |
| OT #60 | Occupational Therapist | Provided feeding equipment recommendations. |
Inspection Report
Complaint Investigation
Capacity: 60
Deficiencies: 25
Date: Nov 20, 2023
Visit Reason
Multiple isolated and patterned Level 2 deficiencies related to quality of care, resident rights, dietary services, and life safety code issues; all corrected by January 2024.
Findings
Multiple isolated and patterned Level 2 deficiencies related to quality of care, resident rights, dietary services, and life safety code issues; all corrected by January 2024.
Deficiencies (25)
Activities meet interest/needs each resident
ADL care provided for dependent residents
Assistive devices - eating equipment/utensils
Develop/implement comprehensive care plan
Food procurement,store/prepare/serve-sanitary
Medicaid/medicare coverage/liability notice
Nutritive value/appear, palatable/prefer temp
Quality of care
Resident call system
Resident rights/exercise of rights
Responsibilities of providers; required notif
Safe/clean/comfortable/homelike environment
Sufficient nursing staff
Cooking facilities
Corridor - doors
Doors with self-closing devices
Electrical systems - essential electric syste
Elevators
Fire alarm system - testing and maintenance
Gas equipment - cylinder and container storag
Hazardous areas - enclosure
Maintenance, inspection & testing - doors
Portable fire extinguishers
Sprinkler system - installation
Sprinkler system - maintenance and testing
Inspection Report
Annual Inspection
Census: 241
Deficiencies: 12
Date: Nov 20, 2023
Visit Reason
The recertification and abbreviated surveys were conducted to assess compliance with regulatory requirements for St Camillus Residential Health Care Facility.
Findings
The facility was found deficient in multiple areas including residents' rights, care planning, activities, treatment and care, staffing, food quality, adaptive equipment, food safety, and call system accessibility. Several residents experienced unmet needs due to insufficient staffing and procedural lapses.
Deficiencies (12)
F 0550: The facility did not ensure residents received mail on Saturdays, denying 241 residents their rights to exercise their rights as citizens.
F 0582: The facility failed to provide appropriate Medicare Non-Coverage notices to 1 of 3 residents discharged from Medicare Part A services.
F 0584: The facility did not ensure a safe, clean, comfortable, and homelike environment; observed disrepair of mattresses and furniture, unclean medication rooms, and non-homelike meal service on trays for multiple units.
F 0656: The facility failed to develop and implement comprehensive care plans meeting residents' medical and psychosocial needs for 4 of 5 residents, including missing isolation precautions, unimplemented treatments, and lack of supervision during meals.
F 0677: The facility did not provide adequate assistance with activities of daily living for 5 of 7 residents, including lack of showers, oral hygiene, fingernail care, and shaving.
F 0679: The facility failed to provide meaningful activities tailored to residents' interests and needs for 2 of 2 residents, including lack of preferred activities and non-functional television.
F 0684: The facility did not provide treatment and care according to orders for 1 resident with unstageable pressure wounds; treatments were not documented as completed on multiple days.
F 0725: The facility did not provide sufficient nursing staff to meet resident needs, resulting in delayed call bell responses, missed care, and inadequate supervision for 10 residents expressing concerns.
F 0804: The facility did not ensure food was palatable, flavorful, accurate, and served at appropriate temperatures for 3 meals reviewed; meal trays were missing items and some food was burned or cold.
F 0810: The facility failed to provide special eating equipment as ordered for 2 residents; scoop plates and adaptive silverware were missing during meal observations.
F 0812: The facility did not ensure food was stored and prepared in accordance with professional standards; single service items were re-used, hood filters were damaged, and ice scoop was improperly stored.
F 0919: The facility did not ensure resident call systems were accessible in bathing areas for 1 resident; call bell was observed out of reach multiple times.
Report Facts
Residents affected: 241
Residents affected: 3
Residents affected: 5
Residents affected: 4
Residents affected: 5
Residents affected: 2
Residents affected: 1
Residents affected: 10
Residents affected: 3
Residents affected: 2
Residents affected: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN #48 | Licensed Practical Nurse | Named in wound treatment documentation and interview regarding incomplete treatments for Resident #146 |
| RN Unit Manager #29 | Registered Nurse Unit Manager | Named in care plan oversight and staffing interviews |
| CNA #40 | Certified Nurse Aide | Named in incontinence care delay incident for Resident #304 |
| LPN #37 | Licensed Practical Nurse | Named in incontinence care delay incident for Resident #304 |
| Chef Manager #62 | Chef Manager | Named in food quality and food safety interviews |
| Recreation Leader #11 | Recreation Leader | Named in activity program interviews |
| OT #60 | Occupational Therapist | Named in adaptive equipment and feeding assistance |
Inspection Report
Follow-Up
Deficiencies: 0
Date: Nov 8, 2023
Visit Reason
The purpose of this visit was to conduct a follow-up from the 9/7/2023 inspection.
Findings
No rule violations were cited as a result of this inspection.
Inspection Report
Complaint Investigation
Census: 20
Deficiencies: 5
Date: Sep 7, 2023
Visit Reason
The visit was conducted to perform a compliance inspection and investigate complaint intakes #GA00238314 and #GA00237625, starting on 2023-09-05 with an onsite visit on 2023-09-07.
Complaint Details
The investigation was initiated due to complaint intakes #GA00238314 and #GA00237625. Findings included bed bug infestations in residents' rooms, failure to relocate affected residents adequately, and lack of awareness by staff of the infestations and bites. Pest control treatments were limited and incomplete, and no family contacts were made for affected residents lacking family or with family out of town.
Findings
The facility failed to maintain electrical outlets and light fixtures in safe condition, had an inadequate pest control program resulting in bed bug infestations affecting multiple residents, failed to ensure bedroom furnishings were clean and in good condition, did not properly update medication administration records, and failed to provide adequate care and services to residents in compliance with regulations.
Deficiencies (5)
Failed to maintain wall type electric outlets and light fixtures in a safe and operating condition.
Failed to ensure that an insect, rodent or pest control program was maintained and conducted to protect residents' health; bed bugs and eggs found in multiple residents' rooms.
Failed to ensure bedroom furnishings included comfortable springs and mattresses that were clean and in good condition for 3 of 6 sampled residents.
Failed to ensure staff updated the Medication Assistance Records (MAR) each time medications were offered or taken.
Failed to ensure each resident received adequate and appropriate care and services in compliance with laws and regulations for 3 of 6 sampled residents.
Report Facts
Residents sampled: 6
Residents affected by bed bugs: 4
Residents with medication MAR issues: 5
Facility census: 20
Heating treatment duration: 24
Heating treatment duration: 36
Heating temperature: 125
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Interviewed regarding electrical outlet plate, pest control, room moves, and medication administration practices | |
| Staff B | Interviewed regarding light fixture bulbs and pest control awareness | |
| Staff C | Observed and interviewed regarding medication preparation and MAR documentation | |
| EF | Pest control company representative interviewed about treatment methods and limitations |
Inspection Report
Complaint Investigation
Deficiencies: 3
Date: Jul 3, 2023
Visit Reason
The purpose of this visit was to investigate intake #GA00232271, #GA00235290, and #GA00236220 with an on-site visit conducted from 07/03/2023 to 07/12/2023.
Complaint Details
The visit was complaint-related, investigating three intake numbers (#GA00232271, #GA00235290, and #GA00236220).
Findings
The facility failed to maintain an effective pest control program, with live bed bug activity observed in 7 of 10 resident rooms and on a resident. Poisons and chemical pest control materials were improperly stored and accessible in resident rooms and other areas. Additionally, the facility failed to ensure residents' rights to manage their financial affairs, with missing account records and mishandling of resident-issued government assistance monetary cards.
Deficiencies (3)
Failed to ensure an effective insect, rodent or pest control program; live bed bug activity observed in 7 of 10 resident rooms and on a resident.
Failed to ensure poisons, caustics, and other dangerous materials were stored and safeguarded away from residents and food/medication areas; unsecured aerosol cans of bed bug spray found in 6 of 10 resident rooms and chemical pest controls in the front office.
Failed to ensure residents' right to manage their own financial affairs; missing account book and balance for resident accounts, and improper handling of resident-issued government assistance monetary cards.
Report Facts
Resident rooms with live bed bug activity: 7
Resident rooms with unsecured aerosol cans of bed bug spray: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Interviewed regarding bed bug activity, pest control practices, and resident financial affairs; stated lack of knowledge about residents having chemical sprays and missing pest control receipts. | |
| Staff B | Interviewed regarding knowledge of bed bug infestations and use of pest control sprays. |
Inspection Report
Complaint Investigation
Deficiencies: 2
Date: Jun 14, 2022
Visit Reason
The purpose of this visit was to conduct a compliance inspection and investigate intake #GA00224346.
Complaint Details
Investigation of intake #GA00224346 regarding pest infestation and cleanliness issues in the facility.
Findings
The facility failed to maintain a safe and clean environment for residents, with multiple observations of live and dead bed bugs and roaches in residents' rooms and common areas. Clutter and inadequate housekeeping were noted, and residents remained in rooms despite infestation due to unavailability of alternate rooms.
Deficiencies (2)
Facility failed to ensure the home was maintained to provide adequately for all health, safety, and well-being of residents, with bed bugs and roaches observed in rooms and common areas for 3 of 4 sampled residents.
Facility failed to ensure the home cleaned residents' living spaces periodically and as needed to prevent health hazards for 3 of 4 sampled residents.
Report Facts
Bed bugs observed: 20
Bed bugs observed: 15
Roaches observed: 6
Inspection Report
Renewal
Deficiencies: 1
Date: Jul 30, 2021
Visit Reason
The inspection was a recertification survey conducted from 7/26/21 to 7/30/21 to assess compliance with regulatory requirements for St Camillus Residential Health Care Facility.
Findings
The facility failed to provide residents with ongoing programs supporting their choice of meaningful activities, specifically for Residents #2 and #31. Resident #2 was not offered meaningful activities or materials, and Resident #31 was not provided music as care planned.
Deficiencies (1)
F 0679: The facility did not provide each resident an ongoing program to support their choice of activities designed to meet their interests and support their physical, mental, and psychosocial well-being for 2 of 3 residents reviewed. Resident #2 was not offered meaningful activities or materials, and Resident #31 was not provided music of their choosing as care planned.
Report Facts
Days with documented activities for Resident #31: 17
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Certified Nurse Aide #6 | Certified Nurse Aide | Mentioned in relation to Resident #2's activity participation and observations. |
| Certified Nurse Aide #7 | Certified Nurse Aide | Reported on activities aide #4 providing activities and music for Resident #31. |
| Registered Nurse Unit Manager #8 | Registered Nurse Unit Manager | Reported on Resident #31's music preferences and stimulation. |
| Activities Aide #4 | Activities Aide | Provided information on activity provision and challenges during the COVID-19 pandemic. |
| Director of Recreation | Director of Recreation | Discussed activity session expectations and staffing challenges. |
Inspection Report
Complaint Investigation
Deficiencies: 4
Date: Jun 24, 2021
Visit Reason
The purpose of this visit was to conduct a compliance inspection and investigate intakes #GA00214765 and #GA00210297.
Complaint Details
The inspection was conducted in response to complaint intakes #GA00214765 and #GA00210297.
Findings
The facility failed to maintain an adequate hot water system with water temperature not exceeding 120°F, failed to ensure unlicensed staff demonstrated medication skills competency, failed to update the Medication Assistance Record (MAR) properly, and failed to obtain record check applications for direct access employees.
Deficiencies (4)
The facility failed to ensure the hot water system supplied water not exceeding 120 degrees Fahrenheit; water temperature was found at 131.4 degrees F in Resident #4's bathroom.
Unlicensed staff (Staff B and Staff C) did not demonstrate medication skills competency as required; no documentation was found.
Staff failed to update the Medication Assistance Record (MAR) each time medication was offered or taken for Resident #5.
The facility failed to obtain record check applications for direct access employees (Staff B and Staff C) upon application or prior to placement.
Report Facts
Water temperature: 131.4
Number of sampled staff with missing medication competency documentation: 2
Number of sampled staff with missing record check applications: 2
Number of missed MAR initials: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Witnessed water temperature reading and provided interview statements regarding hot water and medication administration | |
| Staff B | Sampled staff lacking medication competency documentation and record check application; admitted to not signing MAR | |
| Staff C | Sampled staff lacking medication competency documentation and record check application; reported resident refusal of medication |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Nov 10, 2020
Visit Reason
The purpose of this inspection was to investigate intake #GA00209012.
Complaint Details
Investigation started on 2020-11-04 and was completed on 2020-11-10. No rule violations were found.
Findings
No rule violations were cited as a result of this investigation.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Nov 19, 2019
Visit Reason
The visit was conducted to investigate intake # GA0020069.
Complaint Details
Investigation of intake # GA0020069 found no rule violations.
Findings
No rule violations were cited as a result of this investigation.
Inspection Report
Routine
Deficiencies: 0
Date: Jul 17, 2019
Visit Reason
The purpose of this visit was to conduct a compliance inspection.
Findings
No rule violations were cited as a result of this inspection.
Inspection Report
Annual Inspection
Deficiencies: 5
Date: Jun 4, 2019
Visit Reason
The inspection was a recertification survey to assess compliance with federal and state regulations for nursing home operations.
Findings
The facility was found deficient in multiple areas including failure to post the most recent Federal Life Safety Code survey results, inadequate nutritional care for a resident, improper medication storage and labeling, serving food at unsafe temperatures, and lapses in infection prevention and control practices.
Deficiencies (5)
F 0577: The facility did not post the most recent Federal Life Safety Code survey results in locations accessible to residents and their representatives.
F 0692: Resident #136 did not receive the ordered nutritional supplement amount, supplements were left without confirmation of consumption, and a replacement meal was not provided after the resident's breakfast tray was spilled and removed.
F 0761: Insulin multi-dose vials for Residents #11 and #145 were outdated and not discarded after 28 days as required by facility policy.
F 0804: Food was served at unsafe temperatures during 2 of 3 meals tested, including fried fish at 101-107°F and eggs at 98°F, below recommended safe serving temperatures.
F 0880: The facility failed to maintain an effective infection prevention and control program, including inadequate hand hygiene during medication passes, improper use of personal protective equipment for residents on droplet precautions, and failure to maintain washing machines per manufacturer guidelines.
Report Facts
Residents reviewed for nutrition: 7
Residents affected by nutritional deficiency: 1
Residents affected by medication labeling deficiency: 2
Meals tested for temperature: 3
Residents observed during medication pass: 8
Residents on droplet precautions reviewed: 2
Washing machines reviewed: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN #4 | Licensed Practical Nurse | Named in nutritional supplement administration deficiency and observation. |
| LPN #3 | Assistant Unit Manager Licensed Practical Nurse | Interviewed regarding nutritional supplement procedures and infection control. |
| LPN #9 | Licensed Practical Nurse | Observed not performing hand hygiene during medication pass. |
| CNA #7 | Certified Nurse Aide | Observed not using PPE and hand hygiene during care of residents on droplet precautions. |
| CNA #6 | Certified Nurse Aide | Observed not using PPE and hand hygiene during care of residents on droplet precautions. |
| LPN #15 | Licensed Practical Nurse | Observed not performing hand hygiene during care of resident on droplet precautions. |
| Director of Environmental Services | Interviewed regarding maintenance of washing machines. | |
| Food Service Director | Interviewed regarding food temperature and meal service. | |
| Registered Dietitian #5 | Registered Dietitian | Interviewed regarding nutritional assessment and supplement administration. |
| LPN #11 | Licensed Practical Nurse | Observed during medication cart inspection for insulin vial expiration. |
| LPN #10 | Assistant Unit Manager Licensed Practical Nurse | Interviewed regarding infection control procedures. |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Jul 25, 2017
Visit Reason
The purpose of this visit was to investigate complaint GA00177308.
Complaint Details
Complaint GA00177308 was investigated and found to have no rule violations.
Findings
No rule violations were cited as a result of this inspection.
Inspection Report
Annual Inspection
Deficiencies: 0
Date: Jun 20, 2017
Visit Reason
The purpose of this visit was to conduct an annual inspection of the facility.
Findings
No rule violations were cited as a result of this inspection.
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