The Gables of Pelham Skilled Nursing & Rehab

In the surveyor’s words

From the most serious findings on record at The Gables of Pelham Skilled Nursing & Rehab, in the surveyor’s own words.

• Immediate jeopardy, isolatedF605Feb 10, 2025

  Based on manufacturer's recommendation, review of the facility policy, record review, and interviews, the facility failed to ensure Resident (R)1 was free from chemical restraints, when it was identified that R1 was administered Haloperidol Deaconate (Haldol) for exit seeking, entering patient rooms. The medication was not ordered for an approved indication of use. On 02/07/25 at 2:20 PM, the State Agency (SA) determined that the facility's non-compliance with one or more federal health, safety, and/or quality regulations has caused or was likely to cause serious injury, serious harm, serious impairment, or death. […]

• Immediate jeopardy, isolatedF689Feb 10, 2025

  Based on review of the facility policy, record review, and interviews, the facility failed to ensure that adequate supervision was in place to prevent Resident (R)1 from eloping from the facility. On 12/17/24 at approximately 9:33 PM, R1 was found outside of an exit door on the C-Unit of the facility. Licensed Practical Nurse (LPN)1 stated that they heard the alarm sounding off from another unit and felt cold air coming from the door while walking down the hallway. R1 was observed outside of the door in his wheelchair and stated that he was picking berries from the bush. On 12/17/24 at approximately 9:33 PM, the weather was 54 degrees Fahrenheit (F). […]

• Actual harm, isolatedF656Jun 30, 2022

  Based on policy review record review, and interview, the facility failed to develop a comprehensive plan of care for caregivers to follow for 1 Resident (R)24 of 6 residents reviewed for falls and accidents in a total sample of 12 residents. This failure resulted in harm when one staff instead of two staff changed R24's position in bed resulting in R24 rolling off the bed, sustaining a fracture of two bones in the leg, requiring an extended hospital stay, and resulting in a decline in functional mobility. […]

• Actual harm, isolatedF689Jun 30, 2022

  Based on policy review, observation, interview, and record review, the facility failed to provide care in a manner that prevented injuries for 1 Resident (R) 24 of 6 residents reviewed for falls/accidents in a total sample of 12 residents. R24 was rolled onto her side away from the staff caring for her and continued to roll off of the bed onto the floor. This resulted in harm to R24 who sustained broken bones in her leg, a hospitalization of nine days, and functional limitations of movement and mobility. Findings include: Review of the undated facility policy titled, Condition Change of the Resident, documented the procedure to be .After all resident falls, possible injuries, or changes in physical or mental function .7. Monitor resident's condition frequently until stable. 8. […]

• No harm, potential for more than minimal, widespreadF812Jul 24, 2025

  Based on observations, interviews, and review of the facility policy, the facility failed to ensure foods that are stored in the freezer, refrigerators and dry food storage were appropriately sealed, labeled and dated with a use by date and/or discarded after the manufacturer's expiration date. In 2of 2Kitchens, 1of 2Freezers, 1of 2Refrigerators and 1 of 1 Dry Foods Storage.Review of the facility's policy titled Food Receiving and Storage last revised July 2024 revealed, Foods shall be received and stored in a manner that complies safe food handling practices. 7) Dry foods that are stored in bins will be removed from original packing, labeled and dated (use by date). Such food will be rotated using a first in - first out system. 8. […]