Mount Sinai South Nassau T C U

In the surveyor’s words

From the most serious findings on record at Mount Sinai South Nassau T C U, in the surveyor’s own words.

• No harm, potential for more than minimal, isolatedF550Oct 22, 2024

  Based on observation, record review, and interviews during the Recertification Survey initiated on 10/17/2024 and completed on 10/22/2024, the facility did not ensure that each resident was treated with respect and dignity in a manner and in an environment that promotes maintenance or enhancement of quality of life. This was identified for one (Resident #64) of 10 sampled residents. Specifically, Nurse Practitioner # 1 was observed on 10/17/2024 walking into Resident # 64's room without knocking on the resident's door. […]

• No harm, potential for more than minimal, isolatedF655Oct 22, 2024

  Based on observations, record review, and interviews during the Recertification Survey initiated on 10/17/2024 and completed on 10/22/2024 the facility did not ensure that each resident had a Baseline Care Plan that included instructions to provide effective person-centered care that meets professional standards. This was identified for one (Resident #165) of one resident reviewed for skin conditions. Specifically, Resident #165 was assessed as at risk for falls and was placed on tele-sitter remote visual monitoring using a camera in the resident's room. The resident's care plan interventions did not include the tele-sitter remote visual monitoring. […]

• No harm, potential for more than minimal, isolatedF656Jun 16, 2023

  Based on observation, record review and interviews during the Recertification Survey initiated on 6/14/2023 and completed on 6/16/2023 the facility did not ensure that a person-centered care plan for each resident was developed and implemented that includes measurable objectives and time frames to meet a resident's medical and nursing needs. This was identified for one (Resident #117) of one resident reviewed for hydration. Specifically, on 6/14/2023 Resident #117 was administered Packed Red Blood Cells (PRBC). There was no documented evidence in the medical record of a Care Plan related to blood transfusion that included goals and interventions to monitor the resident during and after the blood transfusion. […]

• No harm, potential for more than minimal, isolatedF842Jun 16, 2023

  Based on observation, record review and interviews during the Recertification Survey initiated on 6/14/2023 and completed on 6/16/2023, the facility did not ensure that resident records were complete and accurately documented in accordance with professional standards of practice. This was identified for one (Resident #69) of one resident reviewed for Skin Condition. Specifically, Resident #69 was admitted to the facility with a left dorsal (back) hand and forearm discoloration, however, there was no documented evidence of the identified left-hand and forearm discolorations in the medical record. The finding is: Resident #69 was admitted with diagnoses that included Type II Diabetes Mellitus, Hypertension, and Heart Failure. […]

• No harm, potential for minimal, widespreadF868Dec 24, 2025

  Based on record review and interviews during the Recertification Survey initiated on 12/22/2025 and completed on 12/24/2025, the facility did not ensure it maintained a quality assessment and assurance committee that included the Infection Preventionist (IP) as a member of the committee. Specifically, the Infection Preventionist did not participate and report on the Infection Prevention and Control Program (IPCP) and on incidents (for example health care associated infections) regularly to the Quality Assurance & Performance Improvement committee meetings that were held from 03/31/2025 through 09/11/2025.The finding is:The facility's policy titled Quality Management/Performance Improvement dated 09/2025 documented that all staff participates in the performance improvement process. […]