Based on interview and record review, it was determined that the facility failed to implement antibiotic use protocols that address unnecessary or inappropriate antibiotic use for 1 of 6 residents reviewed for antibiotic stewardship. (Resident identifiers is #38.) Findings include:Resident #38Review on 8/21/25 of Resident #38's physician's order revealed an order dated 7/7/25 for Cipro for an UTI.Review on 8/21/25 of Resident #38's medical record revealed no antibiotic time out was completed for the above antibiotic.Review on 8/21/25 of Resident #38's Revised McGeer Criteria for Infection Surveillance Checklist, dated 8/5/25, for the UTI infection on 7/7/25 did not meet criteria.Interview on 8/21/25 at 8:12 a.m. with Staff A (Director of Nursing) confirmed that the above facility's policy titled Antibiotic Management did not include Antibiotic Stewardship or the use of an antibiotic time out. Further interview revealed that the facility did not document time-outs for antibiotic use. Staff A revealed that the facility follows the CDC for antibiotic use guidelines.Review on 8/21/25 of the CDC (Centers for Disease Control and Prevention) Core Elements of Antibiotic Stewardship for Nursing Homes, dated 3/18/24 and retrieved from https://www.cdc.gov/antibiotic-use/hcp/core-elements/nursing-homes-antibiotic-stewardship.html revealed, . Standardize the practices which should be applied during the care of any resident suspected of an infection or started on an antibiotic. These practices include improving the evaluation and communication of clinical signs and symptoms when a resident is first suspected of having an infection, optimizing the use of diagnostic testing, and implementing an antibiotic review process, also known as an antibiotic time-out, for all antibiotics prescribed in your facility. Antibiotic reviews provide clinicians with an opportunity to reassess the ongoing need for and choice of an antibiotic when the clinical picture is clearer and more information is available.Review on 8/20/25 of the facility's policy tiled Antibiotic Management revealed, As any type of medication, if an antibiotic is to be started, it will be on an individualized based on the symptom criteria, the prescriber will order as based on resident's history and clinical situation. The MD/NP [Medical Doctor/Nurse Practitioner] will order any lab work that may be expected while on a specific antibiotic. The antibiotic prescribed should be of the narrowest of the spectrum for achieving the intended effect.

Based on observation, interview, and record review, it was determined that the facility failed to ensure sanitization of dishware in 1 of 1 kitchen observed.Findings include:Review on 8/20/25 of the facilities policy High-Temperature Dish out of temperature policy, undated, revealed the following: .Required temperature (per regulatory standards) .Final Rinse Cycle: Minimum temperature 180 degrees F [Fahrenheit] . 1. Immediate Verification Check the machine's temperature gauges. Confirm accuracy with a thermometer or heat sensitive test strip on dishes during the final rinse. Record out-of-range reading in the dishwasher temperature log.3 .Do not continue dishwashing until proper sanitation can be ensured. 4. Implement Back up Sanitation .Switch to 3- Compartment Sink Method .Observation on 8/19/25 at approximately 8:14 a.m. in the kitchen revealed Staff E (Cook) loading morning dirty dishes into the high temperature dish machine. The dish machine achieved a maximum temperature of 172 degrees Fahrenheit during the final rinse. Observation on 8/19/25 at approximately 12:45 p.m. in the kitchen with Staff C (Director of Dietary Services) revealed the high temperature dish machine achieved a maximum temperature of 168 degrees Fahrenheit during the final rinse. Review on 8/19/25 of the Dish machine temperature logs, revealed that the final rinse temperature of the dish machine had not been recorded since 7/28/25.Interview on 8/19/25 at approximately 12:45 p.m. in the kitchen with Staff C confirmed the above findings. Further interview with Staff C revealed that the dishes washed in the morning at a final rinse of 172 degrees Fahrenheit were not rewashed and were used to serve lunch.

Based on observation, interview, and record review, it was determined that the facility failed to determine if self-administration is appropriate for a resident for 1 of 1 resident reviewed for respiratory care. (Resident Identifier #152). Findings include: Observation on 8/13/24 at approximately 9:15 a.m. of Resident #152 revealed Resident #152 sitting up in their recliner chair with 3 medicine cups sitting on the side table next to them. Further observation revealed one medicine cup to contain seven pills and three capsules, and the two other medicine cups to each contain a liquid (one was very light blue in color and the other was a pale orange color). Interview on 8/17/24 at approximately 9:20 a.m. with Staff E (Registered Nurse (RN)) confirmed the above findings. Further Interview with Staff E revealed that the medication cups observed contained Resident #152's morning medications that were administered by Staff F (RN). Staff E confirmed that Resident #152 does not have an order to self administer medications and does not have an assessment to self administer their medications. Interview on 8/13/24 at approximately 1:30 p.m. with Staff C (Director of Nursing) confirmed that Resident #152 should not be self administering their medications. Review on 8/14/24 of facility policy titled, Medication Administration General Guidelines, effective 1/21, revealed: .15. Residents are allowed to self-administer medications when specifically authorized by the prescribe, the nursing care center's interdisciplinary Team [IDT], and in accordance with procedures for self-administration of medications and state regulations . Review on 8/14/24 of facility policy titled, Medication Administration Self-Administration by Resident, effective 11/17, revealed: .Residents who desire to self-administer medications are permitted to do so with a prescriber's order and if the nursing care center's interdisciplinary team has determined that the practice would be safe and the medications are appropriate and safe for self-administration .

Based on interview, record review, and policy review, it was determined that the facility failed to implement an ongoing systematic collection of surveillance data during a SARS-CoV-2 (COVID-19) outbreak from 7/7/24 to 7/25/24 and failed to ensure a system for identifying residents with COVID-19 through timely testing for 1 of 10 residents reviewed with respiratory symptoms (Resident Identifier is #99). Findings include: Interview with Staff C (Director of Nursing) on 8/13/24 revealed that Staff C was providing a new COVID-19 Line List for July 2024, originally provided on 8/12/24, due to some inaccuracies identified by the facility that had been corrected. Review on 8/13/24 of the facility's COVID-19 Line List for July 2024, received on 8/13/24, revealed changes had been made to the list provided on 8/12/24 related to symptom onset, test collection dates, and symptom information. Interview with Staff C on 8/14/24 revealed that Staff C was providing a new COVID-19 Line List for July 2024 to replace the list provided on 8/13/24, due to additional inaccuracies identified by the facility that had been corrected. Review on 8/14/24 of the facility's COVID-19 Line List for July 2024, received on 8/14/24, revealed additional changes had been made to the list provided on 8/13/24 related to symptom onset, test collection dates, and symptom information. Further review revealed that Resident #99 was on the COVID-19 Line List provided on 8/14/24 and it indicated that Resident #99's symptoms started on 7/7/24. Review on 8/12/24 of Resident #99's medical record revealed a Progress Note dated 7/6/24 that stated: Resident continues with cold sx [symptoms] prn [as needed] tussin [cough medication] given at 0945 [9:45 a.m.] and 1345 [1:45 p.m.] with positive effect. Resident refused neb [nebulizer] tx [treatment]. Resident was put on O2 [oxygen] on the previous shift for O2sat 90% RA [Oxygen saturation at 90% on room air] with dyspnea [shortness of breath]. O2 has had good effect 95% 2L/min [2 liters per minute] via nasal canula. Interview on 8/14/24 with Staff C confirmed the above findings and the above progress note stating Resident #99 had respiratory symptoms prior to 7/6/24. The provider ordered a COVID-19 test for Resident #99 on 7/7/24 and the result was positive. Review on 8/14/24 of facility policy titled, Webster at Rye COVID-19 Resident and Staff Testing Policy revealed: Webster at Rye follows the latest CDC [Center for Disease Control and Prevention] guidelines for testing for COVID-19 of residents and staff. Review on 8/14/24 of the Center for Disease Control and Prevention guidance Infection Control Guidance: SARS-CoV-2, dated 6/24/24, accessed at https://www.cdc.gov/covid/hcp/infection-control/index.html, revealed the following: Anyone with even mild symptoms of COVID-19, regardless of vaccination status, should receive a viral test for SARS-CoV-2 as soon as possible.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and medical record review it was determined that the facility failed to ensure the resident's right to formulated advance directives for 1 out of 13 residents reviewed for advance directives (Resident Identifier is #13). Findings include: Review on [DATE] of Resident #13's Electronic Health Record (EHR) revealed that Resident #13 was a full code. Review on [DATE] of Resident #13's paper medical record revealed on the chart binder a sticker indicating full code. Further review of Resident #13's paper medical record revealed that Resident #13 had a Do Not Resuscitate (DNR) order signed by the physician on [DATE]. Interview on [DATE] at approximately 12:10 p.m. with Staff A (Registered Nurse) revealed that he/she would first look at the band on a resident's arm to determine a residents code status, if resident did not have a wrist band on he/she would then look in the EHR, and lastly would check the binder of a residents paper medical record. Observation on [DATE] at approximately 12:12 p.m. of Resident #13's arms revealed that he/she was not wearing a wrist band. Interview on [DATE] at approximately 12:13 p.m. with Resident #13, their spouse, and Staff A revealed that Resident #13 wishes to be a DNR. Review on [DATE] of the facility policy titled, Advance Directives, dated [DATE] revealed: . 7. Code Status Consent- This form will be completed by the resident and/or the activated DPOA (Durable Power Of Attorney) for healthcare or guardian. This consent indicates the resident's desire relative to CPR (Cardio Pulmonary Resuscitation). It may be revised at any time. If there is a change in status, it must be documented in the medical record by the physician. Code Status is in effect when signed and order placed in medical record. 8. Wrist Band- Blue wrist, indicating DNR, will be applied by nursing staff once code status is established. .

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review it was determined that the facility failed to follow physician's orders for 1 resident in a final sample of 13 residents (Resident Identifier is #34). Based on interview and record review determined that the facility failed to monitor a resident's weight for 1 resident reviewed in a final sample of 13 residents. (Resident Identifier is #32). Findings include: Resident #34 Review on 6/6/23 of Resident #34's Medication Administration Record (MAR) revealed the following physician's orders: May 2023 Amlodipine Besylate Oral Tablet 10 milligrams (mg) Give 1 tablet by mouth one time a day for Hypertension (HTN), Hold for Systolic Blood Pressure (SBP) less than 120/70, order date 4/28/23. May 13th SBP was 109 and medication was documented as being administered. June 2023 Amlodipine Besylate Oral Tablet 10 mg, Give 1 tablet by mouth one time a day for HTN, Hold for SBP less than 120/70, order date 4/28/23. June 5th SBP was 110 and medication was documented as being administered. Interview on 6/7/23 at approximately 8:45 a.m. with Staff B (Assistant Director of Nurses) confirmed the above findings. Review on 6/7/23 of the facility policy titled, Medications, undated revealed: .1. Drugs must be administered in accordance with the written orders of the attending physician. Resident # 32 Review on 6/6/23 of Resident #32's medical record revealed that he/she was admitted to the facility on [DATE] with a diagnosis of Congestive Heart Failure (CHF). Review on 6/6/23 of Resident #32's weights revealed the following weights: 5/15/23 weight was 236.8 obtained with hoyer 5/29/23 weight was 224.0 obtained with hoyer 6/5/23 weight was 228.6 obtained while sitting Interview on 6/7/23 at approximately 10:00 a.m. with Staff B (Assistant Director of Nursing) confirmed that there was no documented weight on admission until 4 days after admission and that there was no reweight done on 5/29/23 with a 12.8 pound loss being identified until 6/5/23. Review on 6/7/23 of the facility policy titled, Weight and Height Documentation, Revised on 4/22 revealed: All residents are to have a height and weight done upon admission. All residents/patients are to be weighed weekly on their shower/bath day. Each resident must be weighed on the same scale each week and with all the items. If there is a three-pound discrepancy from the previous weight, reweigh at that time and be sure scale is calibrated.

Based on observation, interview, and record review it was determined that the facility failed to ensure that medications were labeled with an opened date or use by date and expired medications were removed from use for 1 out of 2 medication carts and 1 out of 1 medication room observed (Resident Identifiers are #26 and #96). Findings include: Southwest Medication Cart Observation on 6/6/23 at approximately 8:00 a.m. of the medication room with Staff C (Registered Nurse) revealed the following: Resident #26's Timolol Meleate 0.5% [percent] eye drop with an opened date of 3/25/23 and a pharmacy sticker that stated discard 60 days after opening; Resident #96's Dorzolamide HCL [Hydrochloric acid] 2% Ophthalmic Solution (eye drop) with no opened date and a pharmacy expired sticker dated 5/31/23. Interview with on 6/6/23 at approximately 8:15 a.m. with Staff C confirmed the above findings. Staff C confirmed that the medications identified were currently ordered and in use. Facility Medication Room Observation on 6/6/23 at approximately 8:30 a.m. of the medication room with Staff B (Registered Nurse) revealed the following: Two unopened bottles of Naproxen Sodium 220 milligram (mg) with an expiration date of 4/2023; 1 opened vial of Tuberculin Purified Protein Derivative (Tubersol) with no open or use by date. Interview on 6/6/23 at approximately 8:50 a.m. with Staff B confirmed the above findings. Staff B confirmed the medications were house stock and were currently available for use. Review on 6/7/23 of the facility policy titled Storage of Medication, dated 1/2021, revealed .14. Outdated, contaminated, discontinued or deteriorated medications and those in containers that are cracked, soiled, or without secure closures are immediately removed from stock, disposed of according to procedure for medication disposal . Review on 6/7/23 of Tuberculin Purified Protein Derivative (Tubersol) manufacturer's instructions revealed .A vial of Tubersol which has been entered and in use for 30 days should be discarded .