The Osborn

In the surveyor’s words

From the most serious findings on record at The Osborn, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF925Feb 17, 2023

  Based on observations, interviews, and record review during the recertification and abbreviated surveys (NY00309912), it was determined for two of two resident occupied floors, the facility did not maintain a safe and comfortable environment by not ensuring the exclusion of mice in the facility. Specifically, during an on-site investigation conducted on 2/13/23 through 2/14/23, between the hours of 9:00 AM to 4:00 PM, observation was made of a mouse and mouse droppings in a resident room. The findings are: An observation on 2/13/23 at 10:00 am revealed double doors adjacent to the kitchen were propped open, there was a gap of greater than 1 at the bottom of the doors which would allow mice to enter the facility. […]

• No harm, potential for more than minimal, patternF656Feb 17, 2023

  Based on observation, interview, and record review conducted during the Recertification survey (2/13/23 to 2/17/23), it was determined that the facility did not implement care plan interventions and the facility did not develop a comprehensive person-centered care plan that included measurable objectives and timeframes to meet a resident's medical, and nursing needs that were identified in the comprehensive assessment. Specifically, 1 of 2 residents (#5) reviewed for pressure ulcers had an order for bilateral heel booties that were not being implemented as per the care plan, 1 of 2 residents (#37) reviewed for antipsychotic medications was prescribed an antipsychotic medication but did not have a care plan for antipsychotic medications, and 1 of 1 resident (#43) reviewed for nutrition had… […]

• No harm, potential for more than minimal, isolatedF623Feb 19, 2025

  Based on record review and interviews conducted during the recertification survey from 2/12/25 to 2/19/25, the facility did not ensure that the resident and/or resident representative were notified in writing of the reason for the transfer/discharge to the hospital for one of one residents reviewed for hospitalization (Resident #7). Specifically, Resident #7 was transferred to the hospital and the facility could not provide evidence that a written notice of transfer/discharge was provided to the resident or the resident's representative, and that notification was sent to the Ombudsman Office. […]

• No harm, potential for more than minimal, isolatedF625Feb 19, 2025

  Based on record review and interview conducted during the Recertification Survey conducted from 2/12/25 to 2/19/2,the facility did not ensure that a resident's representative was informed of the facility's bed hold policy before and upon transfer to a hospital for one of one residents reviewed for hospitalization (Resident #7). Specifically, Resident #7 was transferred to the hospital on 8/22/24, and the facility did not provide the resident or their representative written information regarding the bed hold. Findings include: The policy and procedure titled Bed Hold last revised 3/24/23, documented the resident and the representative would receive bed hold and return information at admission and before a hospital transfer. […]

• No harm, potential for more than minimal, isolatedF645Feb 19, 2025

  Based on record review and interviews during the Recertification survey from 02/12/2025 to 02/19/2025, the facility did not ensure that a complete preadmission screening was conducted. This was evident for 2 (Resident #169 and Resident # 35) residents reviewed for Preadmission Screening and Resident Review (PASARR) of 16 residents. Specifically, the SCREEN DOH - 695 form was incomplete. There was no documentation of answers to items 21, 24, 25, and 26. The findings are: The facility Policy with Title Preadmission Screening and Resident Review (PASARR) with effective date 01/15/2025 and last review date 01/1/2025 documented It is the policy to screen all potential admissions on an individual basis. […]