Below average — CMS composite of the measures below.
A standard survey is most likely before around October 2026
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 Highland Rehabilitation And Nursing Center during CMS and state inspections, most recent first.
A resident with dementia, cerebral infarction, and heart failure experienced multiple significant changes in condition and pain management, including transitions from tramadol and oxycodone to morphine for end-of-life hospice care, increased morphine dosing, initiation of oxygen for low O2 levels, and treatment for fever. Facility policy required notifying the responsible party of significant changes in status and treatment, yet there was no documentation that the family representative was informed of the resident’s increased pain, initiation and escalation of morphine, or other treatment changes. The family only learned of the resident’s decline and morphine use when they called the facility, and interviews with the NP, LPN unit manager, and DON confirmed that such changes should have been communicated and documented but were not.
A resident with hemiplegia, major depressive disorder, and type 2 DM did not receive a timely admission Comprehensive MDS assessment within the required 14-day timeframe. The MDS coordinator allowed the ARD from a prior admission to remain active because the earlier assessment cycle and comprehensive care plan had not been fully closed by all disciplines, and the new stay was incorrectly treated as a readmission without verifying admission status. As a result, the current admission’s comprehensive MDS was not initiated and completed as required and remained overdue, while the administrator reported being unaware of any MDS tracking or ARD issues and had not been informed of the delay.
The facility failed to maintain an effective resident identification system, resulting in one cognitively impaired new admission having no identification band or other identifier and another cognitively intact resident wearing a wristband belonging to a different resident with a similar last name. Staff, including CNAs and the DON, reported that they rely primarily on identification wristbands to identify residents, especially when residents cannot state their names or when staff float to unfamiliar units, and acknowledged that bands may not be promptly applied or replaced and that no alternate identification process was in place when bands were missing or incorrect.
Surveyors found that the facility did not maintain a clean and safe environment, with observations of dirty floors, soiled equipment, and unclean radiators. Staff were unclear about cleaning responsibilities for items like floor mats and wheelchairs. Additionally, a resident's personal food was taken and eaten by a staff member, and subsequent checks revealed ongoing issues with improper food storage and labeling in the resident refrigerator, despite facility policies and staff reminders.
Surveyors found that three residents with severe cognitive impairment and dependence on staff did not receive necessary assistance with ADLs, including mobility and personal hygiene. One resident was not routinely transferred out of bed as required by their care plan, while two others were observed with long, dirty, or stained fingernails due to inconsistent nail care and unclear staff responsibilities.
A resident with severe cognitive impairment and multiple medical conditions was not allowed to receive visits from a friend, despite expressing a desire to do so. Facility staff and the Administrator restricted the friend's visitation based on concerns from a family member and financial safety, even though the family member had no legal authority. The resident was aware of and upset by the restriction, and staff confirmed the resident's wishes to see the friend were not honored.
A resident's belongings or money were wrongfully used due to the facility's failure to safeguard personal property and funds, resulting in a violation of resident rights.
Comprehensive care plans were not reviewed or revised for two residents after significant incidents, including a fall and repeated episodes of aggression. One resident with hemiplegia and pain was not provided updated interventions after a bathroom fall, and another resident with cognitive impairment had no care plan changes following multiple aggressive outbursts. Staff interviews and documentation confirmed the care plans were not updated as required.
A deficiency was cited for not ensuring an area was free from accident hazards and for failing to provide adequate supervision to prevent accidents. The environment did not meet safety standards, and staff did not provide the necessary supervision.
Failure to Notify Family of Significant End-of-Life Condition and Medication Changes
Penalty
Summary
The deficiency involves the facility’s failure to notify a resident’s family representative of significant changes in the resident’s condition, treatment, and medication regimen, as required by facility policy and 10NYCRR 415.3. The facility’s written policy on Change in Resident Status Notification required that the attending physician and responsible party be notified when there is a significant change in the resident’s physical, mental, or psychosocial status, or when there is any situation requiring a change in the plan of care, medications, or treatment regimen. Surveyors reviewed the medical record of a resident with dementia, cerebral infarction, and heart failure, whose MDS documented severely impaired cognition, and found no documented evidence that the family representative was notified of multiple significant changes in condition and pain management. From the dates reviewed, the resident’s pain management regimen changed several times. Initially, the resident was prescribed tramadol 50 mg by mouth every morning and at bedtime for pain, and oxycodone 5 mg by mouth every six hours as needed for pain. Subsequently, the resident was prescribed morphine sulfate 5 mg every six hours as needed for pain, shortness of breath, and restlessness related to end-of-life hospice care, and later morphine sulfate 10 mg buccally every three hours as needed for the same indications. Additional orders included initiation of 2 liters of oxygen via nasal cannula for low oxygen levels and an acetaminophen 650 mg suppository for fever. A nursing progress note documented a call from a hospice nurse reporting increased pain and discussing the resident’s pain regimen, with a plan to follow up with the nurse practitioner, but there was no documentation that the family representative was notified of the increased pain or the potential changes in pain management at that time. The record further showed that the resident’s family representative only received information about the increased morphine dosage after they themselves contacted the facility for an update, at which time they were informed of the dosage increase to address increased pain. The resident later expired, with the time of death documented in the nursing notes. In interviews, the complainant stated they were not notified when morphine was started and were unaware of its use until they called the facility, at which point they were told the resident had been declining for about a week and that medication changes had been made. The nurse practitioner stated that changes such as increasing morphine from 5 mg to 10 mg represent a significant change requiring family notification. The LPN Unit Manager and the Director of Nursing both acknowledged that staff are expected to notify family representatives of significant changes and to document such notifications, and upon review of the progress notes, they were unable to find documentation that the family representative had been notified of the medication and condition changes.
Failure to Complete Admission MDS Assessment Within Required Timeframe
Penalty
Summary
The deficiency involves the facility’s failure to ensure accurate and timely completion of a federally required admission Comprehensive Minimum Data Set (MDS) assessment for one resident. The resident was admitted with diagnoses including hemiplegia and hemiparesis following cerebral infarction, major depressive disorder, and type 2 diabetes mellitus. Facility policy required a systematic MDS scheduling process, including establishment of an Assessment Reference Date (ARD) within the allowable window and maintenance of an MDS scheduling calendar and tracking log. Record review showed that a comprehensive MDS assessment was required within 14 days of admission, but the assessment associated with an ARD of 12/23/2025 was not completed by that timeframe and was already 10 days overdue at the time of the initial record review on 01/02/2026. Interviews and further record review revealed that the MDS coordinator had the resident’s ARD tracking under a prior admission that ended in discharge in August 2025, and the comprehensive care plan from that prior admission had not been completed and closed by all disciplines. This prevented closure of the previous admission assessment cycle and left the prior ARD active, which interfered with the MDS process for the current admission. The MDS coordinator stated that the resident’s new admission had been treated as a readmission and the admission status was not verified, contributing to the failure to complete the new comprehensive assessment within the required 14-day timeframe. The administrator reported being unaware of any MDS or ARD tracking issues and had not been notified of delays. On revisit, the comprehensive assessment for the current admission remained incomplete, with required sections from other disciplines still outstanding and the ARD 35 days overdue.
Failure to Maintain Accurate Resident Identification Wristbands
Penalty
Summary
The deficiency involves the facility’s failure to maintain an effective resident identification system, resulting in residents either wearing incorrect identification wristbands or having no identification at all. During an abbreviated survey, observations on the dementia unit showed multiple residents, including Residents #2 and #5, without identification wristbands despite a facility policy requiring a resident identification system to support the provision of medical and nursing care. Staff interviews confirmed that identification wristbands are the primary method used by CNAs and other personnel, especially when residents cannot state their names or when staff float to unfamiliar units. Resident #5, a newly admitted resident with diagnoses including dementia, myocardial infarction, and peripheral vascular disease, had a recent Comprehensive MDS documenting severely impaired cognition. On observation, this resident had no identification wristband, name tag, or any other identifier in place. When the surveyor asked CNA #1, who was assigned to this resident, to identify them, CNA #1 was unable to do so and stated that residents are supposed to wear identification wristbands and that they could not identify the resident because the resident was new and had no band. The RN Unit Manager acknowledged that identification wristbands are expected to be applied upon admission and that they did not complete this admission and could not explain why the band was not applied. Resident #2, admitted with anxiety disorder, intracardiac thrombosis, and major depressive disorder, had an MDS indicating intact cognition. This resident reported an incident in which they were issued and wore another resident’s identification wristband belonging to a resident with a similar last name. The resident stated that when the podiatrist came to provide routine podiatry services, the podiatrist addressed them by the incorrect name shown on the wristband. The RN Unit Manager and the DON both confirmed that Resident #2 had been found wearing an incorrect identification wristband, but they could not identify which staff member applied it or how long it had been in place. Leadership interviews further revealed that identification wristbands may fall off or break and are not always promptly replaced, and no alternate process was described to ensure resident identification when wristbands are missing or incorrect.
Failure to Maintain Clean Environment and Protect Resident Property
Penalty
Summary
The facility failed to provide a safe, clean, and comfortable environment for residents, as evidenced by multiple observations of uncleanliness and lack of maintenance on Unit 2. Surveyors observed peeling wallpaper, dirty and debris-covered floors, a floor mat with a strong urine odor, a soiled wheelchair, and radiators with air vent grates and metal fins heavily soiled with dirt, dust, dried food, and liquids. Glass balcony doors and windows in the dining room were also found to be dirty and covered with fingerprints and grease. Staff interviews revealed a lack of clarity regarding cleaning responsibilities for floor mats and wheelchairs, with some staff unaware of cleaning schedules or which department was responsible for certain tasks. There was no documentation of regular cleaning for wheelchairs, and spot cleaning was only performed when visible soiling was noticed. Additionally, the facility did not ensure reasonable care for the protection of resident property from loss or theft. One resident, who was cognitively intact and had diabetes and anxiety, reported that their personal food stored in the dining room refrigerator was taken and partially eaten by a staff member. The incident was confirmed through surveillance footage, and the facility acknowledged the misappropriation of the resident's property. Despite reminders and inservice training for staff that only resident food should be stored in the dining room refrigerator, subsequent observations found unlabeled, undated, and spoiled food items, as well as staff food, in the refrigerator. Staff interviews confirmed ongoing issues with labeling and storage of food items, and that dietary staff were responsible for checking and maintaining the refrigerator. Facility policies reviewed by surveyors outlined daily and monthly cleaning procedures for floors and common areas, but did not specify cleaning processes for radiators or floor mats. Policies also required that resident food be labeled and stored separately from staff food, and that perishable items be discarded after 72 hours. However, observations and staff interviews indicated that these policies were not consistently followed, resulting in an environment that did not meet standards for cleanliness, safety, or protection of resident property.
Failure to Provide Assistance with Activities of Daily Living and Personal Hygiene
Penalty
Summary
Surveyors identified that the facility failed to provide necessary care and assistance with activities of daily living (ADLs) for residents who were unable to perform these tasks independently. Specifically, three residents were observed to have unmet needs in the areas of personal hygiene, grooming, and mobility. One resident with severe cognitive impairment and a history of deep vein thrombosis was observed lying in bed on multiple occasions, with no evidence of being assisted out of bed to their wheelchair, despite care plans and medical recommendations indicating the need for regular out-of-bed time and participation in meals and activities outside the resident's room. Interviews with staff revealed that changes to the get-up schedule and staff assignments resulted in this resident no longer being routinely transferred out of bed, contrary to their care plan and physician recommendations. Another resident, also severely cognitively impaired and dependent on staff for personal hygiene and grooming, was observed with long, jagged, yellow and brown stained fingernails. The care plan for this resident required regular nail care due to fragile skin and risk of self-injury. However, the assigned Certified Nurse Aide stated that nail care was only performed on Fridays as part of their personal routine, and if the aide was not assigned to the resident on that day, the nail care was missed. The aide was unaware of the facility's policy regarding nail care frequency, and the resident's nails were not addressed even when observed by nursing staff during medication administration. A third resident, with severe cognitive impairment and dependent on staff for ADLs, was repeatedly observed with dirty, brown-stained fingernails, including while eating meals. Staff interviews revealed that nail cleaning was inconsistently performed, often only during scheduled showers or when activities staff were available. Some staff acknowledged seeing the dirty nails but did not attempt to clean them, and there was a lack of clarity among staff regarding responsibility for ensuring nail hygiene. Nursing staff stated that nail checks were supposed to be part of skin assessments on shower days, but this was not consistently done, resulting in prolonged periods where the resident's nails remained unclean.
Failure to Honor Resident's Right to Visitation
Penalty
Summary
The facility failed to ensure a resident's right to receive visitors of their choosing at the time of their choosing, as required by facility policy and regulation. The deficiency involved a resident with diagnoses including adult failure to thrive, hypertension, and interstitial lung disease, who was noted to have severely impaired cognition. Despite the resident expressing a desire to see their friend, the facility restricted the friend's visitation based on concerns raised by a family member and the Administrator regarding the resident's finances. The family member did not hold legal authority such as health care proxy, guardianship, or power of attorney. The facility communicated visitation limitations to the friend, who did not express concerns at that time. Staff interviews and documentation revealed that the resident consistently expressed a wish to see their friend and was upset about the visitation restrictions. The Administrator acknowledged restricting the friend's visits, citing concerns about the resident's cognitive status and potential financial exploitation, and offered supervised visits, which were declined by the friend. Despite a temporary guardian being appointed by court order to safeguard the resident's assets and determine care providers, the facility continued to restrict visitation, resulting in the resident being unable to see their friend as desired.
Failure to Protect Resident Property and Funds
Penalty
Summary
A deficiency was identified regarding the protection of residents from the wrongful use of their belongings or money. The report documents that the facility failed to ensure that residents' personal property and funds were safeguarded against misuse or unauthorized access. Specific actions or omissions by facility staff led to the wrongful use of a resident's belongings or money, violating the resident's rights and facility policy. No additional details about the residents' medical history or condition at the time of the deficiency are provided in the report.
Failure to Update Care Plans After Falls and Aggressive Behaviors
Penalty
Summary
The facility failed to ensure that comprehensive care plans were reviewed and/or revised for two residents following significant incidents. For one resident with end stage renal disease, hemiplegia, and pain, there was no documented evidence that the care plan was updated after a fall in the bathroom. The resident, who required assistance with mobility and transfers, was found on the floor after attempting to transfer to the toilet, resulting in complaints of pain and an X-ray being ordered. Despite the incident, the care plan was not revised to reflect the fall or to include new interventions, and staff interviews confirmed that the care plan update was not completed as required. Another resident with a history of cerebral infarction and moderate cognitive impairment exhibited multiple episodes of physical and verbal aggression, including throwing objects and attempting to hit staff. Progress notes documented these behaviors on several occasions, but there was no evidence that the care plan was reviewed or revised to address the ongoing aggressive behaviors. The lack of care plan updates following these incidents was confirmed through record review and staff interviews.
Failure to Maintain Accident-Free Environment and Adequate Supervision
Penalty
Summary
A deficiency was identified due to the failure to ensure that a nursing home area was free from accident hazards and that adequate supervision was provided to prevent accidents. The report notes that the environment did not meet safety standards, which could lead to accidents, and that staff did not provide the necessary level of supervision to mitigate these risks. No additional details about specific residents, their medical history, or the exact nature of the hazards or supervision lapses are provided in the report.
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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 Middletown
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Middletown Park Rehab & Health Care Center | 2 mi | ★★★★★ | 1 | 0 |
| Sapphire Nursing And Rehab At Goshen | 6.8 mi | ★★★★★ | 0 | 0 |
| Glen Arden Inc | 7 mi | ★★★★★ | 11 | 0 |
| Campbell Hall Rehabilitation Center Inc | 7.1 mi | ★★★★★ | 19 | 0 |
| The Valley View Center For Nursing Care And Rehab | 7.3 mi | ★★★★★ | 2 | 0 |
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