Spring Harbor at Green Island

In the surveyor’s words

From the most serious findings on record at Spring Harbor at Green Island, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812Jan 18, 2026

  Based on observations, staff interviews, and review of facility policies titled Labeling Food Product and Pots and Pans - Sanitizing Solution, the facility failed to ensure opened food items were properly dated after opening and failed to discard food items after the best by date. In addition, the facility failed to prevent wet-nesting in stored steam table pans to ensure there was no bacterial growth. These deficient practices had the potential to place the 29 residents who were receiving an oral diet from the kitchen at increased risk of contracting a foodborne illness. […]

• No harm, potential for more than minimal, widespreadF812Nov 10, 2024

  Based on observations, interviews, and review of the facility's policy titled, Labeling Food Product, the facility failed to ensure that opened food items were labeled, dated, and secured from open air. The deficient practice had the potential to affect 34 residents who received an oral diet and were served food from the kitchen. Findings included: Review of the facility policy, Labeling Food Product, revised 1/3/2024, revealed that all prepared foods, leftovers and opened products stored for later use would be labeled according to food safety standards along with local and state regulations. […]

• No harm, potential for more than minimal, patternF758Nov 10, 2024

  Based on record review, staff interview, and review of the facility's policy titled, Use of Psychotropic Medication, the facility failed to ensure a stop date was implemented, not to exceed 14 days, for psychotropic medications for three residents (R) (R1, R29, and R7) of six residents reviewed for unnecessary medications. Findings included: Review of the facility's policy titled Use of Psychotropic Medication, revised 1/1/2024, revealed that if the attending physician or prescribing practitioner believed that it was appropriate for PRN (as needed) order to be extended beyond the 14 days, he or she shall document their rationale in the resident's medication and indicate the duration for the PRN order. 1. […]

• No harm, potential for more than minimal, patternF881Jun 4, 2023

  Based on record review, staff interviews, and review of the facility policies titled, Infection Prevention and Control Program and Antibiotic Stewardship Program, the facility failed to provide evidence of a process for periodic review of antibiotic prescribing practices, and to document follow-up measures in response to the data for 11 of 12 months of infection control data reviewed (May 2022 through April 2023). The deficient practice had the potential to affect any resident who was prescribed an antibiotic. Findings include: Review of the facility's policy titled, Infection Prevention and Control Program with a revision date of 11/11/2022 Antibiotic Stewardship: a. An antibiotic stewardship program will be implemented as part of the overall infection prevention and control program. […]

• No harm, potential for more than minimal, isolatedF554Jan 18, 2026

  Based on observations, staff interviews, record review, and review of the facility's policy titled Medication Administration, the facility failed to ensure unauthorized medication was not left at the bedside for one of 20 sampled residents (R) R6. This deficient practice had the potential to place R6 at increased risk of unauthorized use of medication. Findings include:Review of the facility's policy titled Medication Administration, revised 6/11/2025, documented Policy: Medications are administered by licensed nurses, or other staff who are legally authorized to do so in this state, as ordered by the physician and in accordance with professional standards of practice.Review of the facility's electronic medical records (EMR) for R6 revealed diagnoses included, but were not limited to, dry… […]