Rockaway Care Center

In the surveyor’s words

From the most serious findings on record at Rockaway Care Center, in the surveyor’s own words.

• Immediate jeopardy, isolatedF742Apr 25, 2025

  Based on observations, record review, and interviews during an abbreviated survey (NY00376954), the facility failed to ensure that a resident who displayed or was diagnosed with mental disorder or psychosocial adjustment difficulty, received appropriate treatment and services to correct the assessed problem or to attain the highest practicable mental and psychosocial well-being. This was evident in 1 out of 10 residents (Resident #1) sampled for behavioral health. Specifically, from [DATE] through [DATE], Resident #1 who had a diagnosis of Huntington's Chorea Disease (a neurological disorder that causes nerve cells in the brain to break down and die, leading to uncontrolled movements, cognitive decline, and personality changes) exhibited and verbalized suicidal ideation with increased… […]

• Actual harm, isolatedF689Dec 11, 2025

  Based on observation, record review, and interviews during an abbreviated survey (459982), the facility failed to ensure that each resident received adequate supervision and assistance devices to prevent accidents. This was evident in one (1) of 12 residents (Resident #1) sampled for elopement. Specifically, Resident #1 left the building on 02/17/2025 at 4:03 PM after being buzzed out the exit door in the lobby by Security Guard #1. Facility staff did not become aware that Resident #1 was not in the building until 5:35 PM. On 02/18/2025 at 1:20 AM, the hospital notified Nursing Supervisor #2 that Resident #1 was in the hospital. […]

• Actual harm, isolatedF689May 21, 2021

  F689 SS=G Based on observation, interviews and record review conducted during an abbreviated survey (NY 261) from [DATE] to [DATE], the facility staff failed to ensure that each resident receives adequate supervision and assistance devices to prevent accidents. This was evident in 1 out of 5 residents sampled (Resident #1). Specifically, Resident #1 had a history of restless behavior with a previous fall on the floor in the facility. Resident #1 was not adequately supervised; Resident #1 was kept on the standard 2 hourly monitoring. As a result, on [DATE] at 05:38 AM, Resident #1 was observed on the floor at the bedside unresponsive and without pulse with the inner [CONDITION(S)] cannula dislodged and attached to the ventilator tubing. […]

• No harm, potential for more than minimal, widespreadF756Dec 10, 2025

  Number of residents sampled: 5Number of residents cited: 5 Based on observation, record review, and interviews conducted during the Recertification survey, the facility did not ensure the drug regimen of each resident was reviewed at least once a month by a licensed pharmacist. This was evident for five (5) of (5) residents (Resident #4, #10, #7, #6, and #221) reviewed for Unnecessary Medications out of 41 sampled residents. Specifically, there was no documented evidence in the clinical records of Residents #4, #10, #7, #6, and #221 that monthly Medication Regimen Reviews were completed. […]

• No harm, potential for more than minimal, patternF725Dec 10, 2025

  Based on observation, record review, and interviews conducted during the Recertification conducted from 09/24/2025 to 10/01/2025, the facility did not ensure sufficient nursing staff was consistently provided to meet the residents' needs in a manner that promotes each resident's rights, physical, mental, and psychosocial well-being, as determined by resident assessments and individual plans of care. Specifically, 1). Residents reported the facility was short staffed with Certified Nursing Assistants, especially on weekends both days and nights, which resulted in a lack of timely staff response to call bells and delays in performing Activities of Daily Living and personal care. 2). […]