Highfield Gardens Care Center of Great Neck received 32 citations for violations of public health code between 2016 and 2020, according to New York State Department of Health records accessed on March 5, 2020. The Great Neck nursing home’s citations resulted from a total of five surveys by state inspectors. The deficiencies they describe include the following:
1. The nursing home did not provide adequate pressure ulcer care. Section 483.25 of the Federal Code requires nursing homes to provide treatment and services consistent with professional practices to promote the healing of pressure ulcers, heal infection, and prevent new ulcers from developing. A January 2019 citation found that Highfield Gardens Care Center of Great Neck did not ensure such for one resident with a Stage IV sacral pressure ulcer. The citation specifically states that a Licensed Practical Nurse “did not provide treatment consistent with current standards of practice in the maintenance of infection control.” The citation goes on to state that the LPN dressed the resident’s wound and went to wash his hands, at which point the dressing fell off the wound and onto the resident’s briefs. The LPN then put the dressing back on the wound, according to the citation, and when asked by an inspector if the dressing “that he picked up was clean” was unable to answer. In an interview, a Registered Nurse stated that the “dressing that fell on the resident’s brief was not clean and the whole treatment had to be re-done.”
2. The nursing home did not ensure residents’ drug regimens were kept free from unnecessary drugs. Under Section 483.45 of the Federal Code, nursing homes must maintain “each resident’s drug regimen… free from unnecessary drugs.” A July 2017 citation found that Highfield Gardens Care Center of Great Neck did not ensure one resident’s drug regimen was free from unnecessary medications. The citation states specifically that the resident was prescribed an increased in a redacted medication from two 25 milligram tablets, once daily, to three 25 milligram tablets, one daily, “without documented evidence of non-pharmacological interventions attempted prior to the increase, and without a proper indication” for the drug’s use. The citation states that this deficiency had the “potential to cause more than minimal harm.”
3. The nursing home did not take adequate steps to prevent and control infection. Section 483.80 of the Federal Code requires nursing homes to “establish and maintain an infection prevention and control program” that is designed to ensure residents “a safe, sanitary and comfortable environment.” A January 2019 citation found that Highfield Gardens Care Center of Great Neck did not comply with this section. The citation states specifically that the facility had no documentation that it “performed annual sampling and testing of its potable water system for Legionella” for a redacted yearlong period. A plan of correction undertaken by the facility included the contacting of a company to conduct the required sample testing.
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