Pontiac Nursing Home

In the surveyor’s words

From the most serious findings on record at Pontiac Nursing Home, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812Sep 12, 2025

  Based on observations, record review, and interviews during the recertification and abbreviated survey (reference # 532839 [NY00357482]) conducted 9/8/2024 - 9/12/2024, the facility did not ensure food was prepared, distributed, stored, and served in accordance with professional standards for the facility's food services. Specifically, the facility did not ensure prepared foods were cooled properly, stored properly, the food on the steam tables were served at an appropriate temperature during meal service, and nutrition rooms and storage areas were maintained in a clean sanitary condition. Findings included: The facility policy General Sanitation of Kitchen, reviewed 10/8/2024, required defined cleaning tasks, assigned responsibilities, and staff training. […]

• No harm, potential for more than minimal, patternF550Sep 12, 2025

  Based on observations, record review, and interviews during the recertification survey conducted 9/8/2025-9/12/2025, the facility did not ensure residents had the right to a dignified existence in a manner and an environment that promoted the maintenance or enhancement of quality of life for one (1) of one (1) resident (Resident #52) reviewed and twelve (12) of twelve (12) anonymous residents present during a resident group meeting. Specifically, Resident #52 had intact decision-making ability, and the facility involved the resident's family in financial decisions without asking the resident and informed the resident they could not utilize another cognitively intact resident's cellphone even with permission; and twelve residents present at the resident group meeting voiced concerns they… […]

• No harm, potential for more than minimal, patternF656Sep 12, 2025

  Based on observations, record review, and interviews during the recertification survey conducted 9/8/2025-9/12/2025, the facility did not develop and implement a comprehensive person-centered care plan to meet a resident's medical, nursing, mental, and psychosocial needs identified in the comprehensive assessment for four (4) of four (4) residents (Residents #6, #21, #41, and #44) reviewed. Specifically, Resident #6 did not have a care plan that included the use of bed rails; Resident #21 did not have a current care plan addressing behaviors and diabetes with insulin use; Resident #41's care plan was not reviewed and/or revised after Minimum Data Set assessments; and Resident #44's care plan did not include the use of a urinary catheter (a tube to drain urine from the bladder). […]

• No harm, potential for more than minimal, patternF640Feb 15, 2024

  Based on record review and interview during the recertification survey conducted 2/12/2024-2/15/2024, the facility did not electronically submit encoded, accurate and complete Minimum Data Set assessment data to the Centers for Medicare and Medicaid Services System within 14 days after the assessment completion date for 11 of 11 residents (Residents #2, 6, 8, 17, 19, 21, 23, 28, 35, 43, and 50) reviewed for resident assessments. Specifically, the Minimum Data Set assessments for Residents #2, 6, 8, 17, 19, 21, 23, 28, 35, 43, and 50 were not transmitted to the Centers for Medicare and Medicaid Services system within 14 days of completion. […]

• No harm, potential for more than minimal, patternF804Feb 15, 2024

  Based on record review, observation, and interview during the recertification survey conducted 2/12/2024-2/15/2024, the facility did not ensure each resident received and the facility provided food and drink that was palatable, attractive, and at a safe and appetizing temperature for 2 of 2 meals (lunch on 2/13/2024 and breakfast on 2/14/2024) reviewed. Specifically, food was not served at palatable and appetizing temperatures during the lunch meal on 2/13/2024 and the breakfast meal on 2/14/2024. Findings include: The facility policy, Monitoring Food and Liquid Temperatures, reviewed by the facility 9/08/2023, documented the dietary department was to maintain acceptable food temperatures during serving. Temperatures of the food were to be taken and recorded prior to serving. […]