Average — CMS composite of the measures below.
The next survey window likely opens around February 2027
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Brookhaven Health Care Facility, Llc during CMS and state inspections, most recent first.
Medication carts on multiple units were found with unidentified loose tablets, debris from blister packs, dried liquid med residue, a hearing screening device stored without a container, a souffle cup with an unidentified med, and surgical tapes in the drawers. Staff interviews showed an LPN had temporarily stored a prepared med in a drawer, while other nurses and the DON stated loose meds and non-medication items should not be kept in med carts and that carts must be cleaned and maintained properly.
Failure to Document and Authorize Self-Administration of Inhalers: Two residents had albuterol inhalers left at the bedside and stated they used them themselves, but there was no completed interdisciplinary self-medication assessment and no physician order authorizing self-administration. One resident had moderate cognitive impairment and the other was cognitively intact; both had COPD-related inhaler orders that did not include self-administration, and staff interviews confirmed the missing order and incomplete evaluation.
Infection control practices were not followed for two residents. A resident on Enhanced Barrier Precautions had a sacral wound, moderate cognitive impairment, and needed help with dressing and transfers, but a CNA provided high-contact care and made the bed without wearing the required gown. In a separate event, an LPN performed a finger stick on a resident with DM and then cleaned the shared glucometer with a 70% alcohol pad instead of the germicidal disinfectant required by policy and the device manufacturer.
Two residents with cognitive impairments were found self-administering medications without proper assessment or documentation. Medications were left at their bedside without a physician's order or a completed Nursing Evaluation for Self-Administration form. Nursing staff confirmed the practice but acknowledged the lack of documentation and care plans, posing a risk to resident safety.
A facility failed to ensure proper administration and documentation of IV fluids for a resident with a Midline catheter. The dressing was not changed weekly as required, and the external catheter length was not consistently measured and recorded. Nursing staff admitted to lapses in following protocol, including not signing, dating, or measuring the catheter length as per physician orders.
A resident with chronic respiratory failure was not provided continuous oxygen therapy as required, due to an empty oxygen tank. Despite a physician's order for 3 liters per minute via nasal cannula, the tank was not checked at the start of the shift, leading to a lapse in care. Staff interviews confirmed the failure to adhere to the facility's policy on monitoring and changing oxygen tanks.
A resident with a recent history of suicidal ideation did not receive necessary behavioral health care at the facility. Staff were unaware of the resident's mental health history, and the care plan did not address their needs. The resident was found cheeking Xanax to combine with Oxycodone, posing a risk of overdose. The facility failed to implement appropriate suicide prevention measures and lacked coordinated care.
Two residents with cognitive impairments were found with unsecured medications at their bedsides, contrary to facility policy. The residents self-administered inhalers and nasal sprays without physician orders or care plans for self-administration. Nursing staff failed to store medications in locked compartments, as required.
Medication carts contained loose drugs, debris, and non-medication items
Penalty
Summary
Drugs and biologicals used in the facility were not labeled and stored in accordance with accepted professional principles, as shown during a medication storage task on six medication carts across Units A, B, C, and D. Observations found unidentified loose medication tablets in multiple cart drawers, a hearing screening device stored without a container in a medication cart drawer, a souffle cup containing an unidentified medication stored in a drawer, dried residue from spilled liquid medications in a drawer, and surgical tapes stored in a medication cart. Several carts also contained debris from blister pack packaging and were soiled with residue. During interviews, an LPN stated that nurses are responsible for cleaning medication carts and that they try to clean them at the end of their shift. Other nurses stated loose medications and non-medication items should not be in the carts, and one RN said the hearing screening device had been left in the drawer and forgotten. An LPN stated they had temporarily stored a prepared medication in a drawer after becoming busy with another resident, and the DON stated nurses must clean medication carts, clean liquid spills immediately, dispose of loose pills appropriately, and that nurses are not allowed to pre-pour medications or store non-medication items in the carts.
Failure to Document and Authorize Self-Administration of Inhalers
Penalty
Summary
The facility did not ensure that residents had the right to self-administer medications only when the interdisciplinary team determined that the practice was clinically appropriate. Two residents, both with inhalers at their bedside, were identified during observations and record review as having no documented interdisciplinary assessment showing that self-administration was safe, and neither had a physician order authorizing self-administration of the medication. Resident #55 had diagnoses including type 2 diabetes mellitus, COPD, and depression, and a Quarterly MDS documented a BIMS score of 12, indicating moderate cognitive impairment. A nursing self-medication administration data collection tool dated 10/27/2025 was in progress and not completed. The resident had an order for Albuterol Sulfate inhalation aerosol solution, 108 micrograms per actuation, 2 puffs inhaled orally every 6 hours as needed for COPD, but the order did not indicate the resident could self-administer. During observation, the resident stated they used the inhaler themselves as needed and kept it at the bedside, and the inhaler was observed on the overbed table on two separate occasions. Resident #123 had diagnoses including COPD, acute and chronic respiratory failure with hypoxia, and hypertension, and a Quarterly MDS documented a BIMS score of 14, indicating cognitive intactness. The resident had an order for Albuterol Sulfate inhalation aerosol solution, 108 micrograms per actuation, 2 puffs inhaled orally every 6 hours as needed for shortness of breath, but the order did not indicate self-administration. A nursing self-medication administration data collection tool dated 09/23/2025 was in progress and not completed. The resident’s care plan stated the resident preferred medications left at the bedside for self-administration, and during observation the inhaler was noted on the overbed table while the resident stated they used it themselves as needed. Staff interviews confirmed there was no physician order for self-administration for Resident #55, and the DON stated that when a resident wants to self-administer medications, an assessment should be completed by the Social Worker and Nurse and the physician should provide the order.
Infection Control Lapses With Barrier Precautions and Glucometer Disinfection
Penalty
Summary
The facility did not maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. Two residents were identified in the findings: one resident had Enhanced Barrier Precautions ordered and posted on the room door, and another resident required shared glucometer use for blood glucose monitoring. The report cited 10 NYCRR 415.19(a)(1-3). For the resident on Enhanced Barrier Precautions, the resident had diagnoses including type 2 diabetes mellitus, COPD, and depression, and a quarterly MDS documented moderate cognitive impairment. The resident required partial to moderate assistance with lower body dressing and supervision or touching assistance for transfer from bed to chair. The resident also had a sacral wound with an order for Silvadene and an order for Enhanced Barrier Precautions. During observation, a CNA assisted the resident with dressing, transferring to a chair, and making the bed while wearing gloves and a mask but not a gown, despite signage on the room door requiring gowns and gloves for dressing, transferring, changing linens, and hygiene care. The CNA stated they should have worn a gown but forgot, and the DON later stated staff should use gowns and gloves for high-contact activities for residents on Enhanced Barrier Precautions. For the resident receiving glucose monitoring, the resident had diagnoses including type 2 diabetes mellitus, gout, and hypertension, and a quarterly MDS documented moderate cognitive impairment. The resident had an order for Humalog sliding scale insulin before meals and at bedtime. During observation, an LPN performed a finger stick blood glucose check and then cleaned the shared glucometer with a 70% isopropyl alcohol pad instead of the antimicrobial disinfectant required by the facility policy and the glucometer manufacturer’s instructions. Staff interviews showed the LPNs routinely used alcohol wipes, while the unit coordinator, RN educator, and DON stated the facility expected use of germicidal disinfectant wipes and that alcohol wipes were not appropriate for cleaning the glucometer between resident uses.
Failure to Assess and Document Self-Administration of Medications
Penalty
Summary
The facility failed to ensure that residents were assessed and approved to self-administer medications, as required by their policy. This deficiency was identified for two residents who were observed with medications at their bedside without documented evidence of an assessment by the interdisciplinary team. Resident #242, who had moderately impaired cognition, was found with inhalers and a nasal spray in their room, which they self-administered without a physician's order or a completed Nursing Evaluation for Self-Administration form. The nursing staff, including a Licensed Practical Nurse and a Registered Nurse, confirmed the resident's self-administration but acknowledged the lack of documentation and care plan for this practice. Similarly, Resident #293, who had a diagnosis of dementia and moderately impaired cognition, was observed with inhalers and a nasal spray at their bedside. The resident self-administered these medications without a physician's order or an assessment for self-administration. A Licensed Practical Nurse admitted to leaving the medications in the resident's room, despite the resident's cognitive decline and risk of taking multiple doses. The Registered Nurse Unit Manager and the Director of Nursing Services confirmed that the resident had not been assessed for self-administration and that medications should not have been left unattended in the room. The facility's failure to follow its policy on self-administration of medications resulted in residents having access to medications without proper assessment and documentation. The Director of Nursing Services acknowledged that the nursing staff should have completed the necessary evaluations and care plans for self-administration, and that medications should be stored securely if residents are not approved to self-administer. This oversight posed a risk to the residents' safety, particularly for those with cognitive impairments.
Failure in IV Fluid Administration and Documentation
Penalty
Summary
The facility failed to ensure the safe and appropriate administration of intravenous (IV) fluids for a resident, as observed during a recertification survey. Specifically, the facility did not adhere to professional standards of practice, physician orders, and the comprehensive person-centered care plan for a resident with a Midline Intravenous Catheter. The resident, who had a history of retroperitoneal abscess, Methicillin-Resistant Staph Aureus infection, and acute respiratory failure, was observed with a Midline catheter dressing dated 11/01/2024, which was not changed weekly as required. Additionally, the external catheter length was not measured and recorded as per the physician's orders. The facility's policy required Midline dressing changes within 24 hours of new line placement and then weekly, with the external catheter length measured and documented. However, there was no documentation of the dressing change or catheter measurement on 11/09/2024, and subsequent documentation on 11/16/2024 and 11/23/2024 was incomplete or inaccurate. Interviews with nursing staff revealed lapses in following the protocol, including failure to sign, date, and measure the catheter length. The Director of Nursing Services acknowledged the responsibility of registered nurses to perform these tasks weekly and document them accurately.
Failure to Provide Continuous Oxygen Therapy
Penalty
Summary
The facility failed to provide appropriate respiratory care for a resident who required continuous oxygen therapy. The resident, who had a physician's order for oxygen therapy via a nasal cannula at 3 liters per minute, was observed with an empty oxygen tank. This observation occurred during the Recertification Survey, where it was noted that the oxygen tank gauge needle indicated the tank was empty, despite the delivery rate being set correctly. The facility's policy required clinical staff to monitor the oxygen tank gauge during care and at 15-minute intervals, but this was not adhered to. The resident involved had a history of chronic respiratory failure, toxic encephalopathy, and diabetes mellitus type 2, with a documented need for continuous oxygen therapy. Interviews with facility staff, including an LPN and the Director of Nursing Services, revealed that the oxygen tanks should be checked at the beginning of each shift, during medication passes, and at the end of shifts. However, the LPN responsible for the resident's care did not check the oxygen tank until later in their shift, leading to the resident being without the necessary oxygen supply. This oversight was confirmed by multiple staff members, indicating a lapse in following the established protocol for monitoring and changing oxygen tanks.
Failure to Provide Adequate Behavioral Health Care
Penalty
Summary
The facility failed to ensure that Resident #242 received necessary behavioral health care and services, as required to maintain their highest practicable physical, mental, and psychosocial well-being. The resident had a recent history of suicidal ideation and was placed on a three-day suicide watch before being admitted to the facility. However, the direct care staff were not informed of this history, and a person-centered care plan addressing the resident's mental health needs was not developed. The care plan in place did not reflect the resident's history of depression and recent suicidal ideation. Upon admission, the resident was prescribed Quetiapine for sleep and Oxycodone for severe pain, but there was no comprehensive assessment or documentation of the resident's mental health history in the medical records. The social worker and physician assistant involved in the resident's care were unaware of the resident's recent suicidal ideation, and the facility's social work admission assessment did not include this critical information. The resident's psychiatric evaluation and care plan were not adjusted to reflect their mental health needs, leading to inadequate monitoring and support. The nursing staff failed to implement appropriate suicide prevention measures, such as increased monitoring or placing the resident closer to the nursing station. Additionally, there were issues with medication administration, as the resident was found to be cheeking Xanax to combine it with Oxycodone, which posed a risk of overdose. The facility's Director of Nursing Services and other staff members were not fully aware of the necessary steps to address the resident's mental health needs, resulting in a lack of coordinated care and oversight.
Failure to Secure Medications in Resident Rooms
Penalty
Summary
The facility failed to store all drugs and biologicals in secured locked compartments, as observed during a recertification survey. Two residents were identified with medications left unsecured at their bedsides. Resident #242, who had diagnoses including Chronic Obstructive Pulmonary Disease and Congestive Heart Failure, was found with multiple inhalers and a nasal spray at their bedside without a nurse present. The resident self-administered these medications without a physician's order or a care plan for self-administration, and the medications were not stored in a locked drawer. Similarly, Resident #293, diagnosed with Asthma, Dementia, and Chronic Obstructive Pulmonary Disease, had inhalers and a nasal spray left on their bedside table. The resident self-administered these medications, but there was no physician's order for self-administration. The resident's cognitive impairment posed a risk of taking multiple doses, and the medications were left unattended by the nursing staff. Interviews with nursing staff and the Director of Nursing Services revealed a lack of adherence to the facility's policy on medication storage. Medications were supposed to be stored in a medication cart or a locked drawer if residents were cleared to self-administer. However, in both cases, the medications were left unsecured, and there was no documentation or assessment supporting the residents' ability to self-administer their medications.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near East Patchogue
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Swan Lake Nursing & Rehabilitation | 1.4 mi | ★★★★★ | 5 | 1 |
| Bellhaven Center For Rehab And Nursing Care | 2.1 mi | ★★★★★ | 3 | 1 |
| Medford Multicare Center For Living | 3.2 mi | ★★★★★ | 0 | 0 |
| Island Nursing And Rehab Center | 4.1 mi | ★★★★★ | 0 | 0 |
| Sayville Nursing And Rehabilitation Center | 5 mi | ★★★★★ | 0 | 0 |
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