Above average — CMS composite of the measures below.
The next survey window likely opens around November 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 St James Rehabilitation & Healthcare Center during CMS and state inspections, most recent first.
A resident with pneumonia, dementia, and major depressive disorder had an order for continuous O2 at 2 L/min via NC, and staff observed the resident using an oxygen concentrator with the NC in place. However, the comprehensive person-centered care plan did not include oxygen therapy, measurable objectives, or timeframes. The RN manager and DON stated the care plan should have been created when the order was entered into the EMR.
An unqualified CNA applied wound care to a resident’s sacral and buttock pressure ulcers and used a soiled towel from genital care to cleanse the uncovered wounds during morning care. The resident had intact cognition, was at risk for pressure ulcers, and had physician-ordered wound treatment for the affected areas. The CNA said they were not trained to do wound care, an LPN said CNAs are not allowed to apply wound treatments, and the DON stated only nurses may complete wound care.
Failure to obtain timely wound care orders for a resident with a pressure ulcer. A resident was admitted with a Stage 2 pressure ulcer on the buttock, but no wound treatment order was entered and no treatment was provided for several days. The wound care nurse, RN supervisor, and PCP each indicated the order should have been obtained earlier, and the wound was later documented as a Stage 3 pressure ulcer before treatment orders were finally entered.
A resident admitted with a stage 2 pressure ulcer had no wound tx orders in place and no txs were provided for several days after admission. The physician noted the ulcer during a visit but did not document tx recommendations, and the wound was later evaluated as stage 3 before orders for medihoney and dressing changes were entered. The PCP stated they assumed an order existed and acknowledged responsibility for ensuring wound orders were in place.
CNA failed to report a resident’s toe injury to nursing staff after noticing discoloration and a hematoma on the left great toe. The resident had PVD and DM, was cognitively intact, and was dependent for bed mobility and transfers. The CNA said the injury was not a big deal and did not report it because the resident had no pain and the regular nurse was not on duty; the LPN was not informed, and the DON stated the CNA should have reported the change in skin condition.
An unlabeled souffle cup containing a refused Januvia tablet was found in the top drawer of a medication cart during a medication storage observation. An LPN confirmed a resident refused the dose and stored it in the cart instead of discarding it, and the RN supervisor and DON stated refused medication should not be kept in the cart.
A resident with heart failure and moderate cognitive impairment had an order for a no added salt, mechanically altered chopped diet with thin liquids, but was served regular mechanically altered meals with salt packets on the tray. The resident said the wrong meals were being provided and that they sometimes did not eat because of the salt. Staff interviews showed meal tickets were transcribed by dietary staff, CNAs did not verify the prescribed diet, and the RD was unsure why the meal ticket did not match the MD order.
Unlabeled tube feeding formula and water bags were observed for two residents receiving enteral nutrition, despite facility policy requiring the resident’s name, date, and time on feeding sets. One resident had intact cognition and the other had moderate cognitive impairment; both had dysphagia and tube feeding orders in place. In addition, during tray line service, cold food items such as almond milk and yogurt were found above the required temperature limit, and the FSD acknowledged the temperatures were not appropriate.
A resident with stage 3 pressure ulcers on the sacrum and both buttocks received morning care while the wounds were uncovered. A CNA cleansed the wounds with a soiled towel that had been used on the resident's genital area, and wound treatment was reportedly left on the bedside table for the CNA to apply after the bed bath. Staff interviews showed conflicting practice, while the wound care nurse and DON stated only licensed nurses were allowed to complete wound care.
The facility failed to ensure proper food storage and hand hygiene practices. Opened and undated food packages, debris, and food residue were found in the kitchen, and staff did not perform hand hygiene after touching a garbage can and fixing their hair before handling meal trays. These issues were confirmed through observations and staff interviews.
The facility did not ensure a resident's right to make choices about their life by not allowing access to outside food brought by a family member, despite the resident being competent to make informed medical decisions. The facility repeatedly educated the resident and family about dietary restrictions but chose to confiscate and return the food instead.
A resident with severely impaired cognition received the wrong type of insulin due to an LPN's error, despite the facility's policy requiring verification of insulin type and administration method. The resident's blood sugar level was below the threshold for administering the fast-acting insulin, leading to a significant medication error.
The facility failed to provide a sanitary and comfortable environment, as evidenced by the presence of live and dead roaches in the conference room and poor sanitation practices in the kitchen. Despite having a pest control policy, the facility did not effectively implement it, leading to multiple instances of insect activity and inadequate cleaning.
Missing Care Plan for Oxygen Therapy
Penalty
Summary
A comprehensive person-centered care plan was not developed for Resident #24 to address the resident’s oxygen therapy needs, and the care plan did not include measurable objectives or timeframes. Resident #24 was admitted with diagnoses including pneumonia, dementia, and major depressive disorder, and the Minimum Data Set assessment documented severe cognitive impairment with a Brief Interview for Mental Status score of 00. The assessment also documented that the resident received oxygen therapy. A physician’s order dated 11/18/2025 directed oxygen therapy at 2 liters per minute via nasal cannula continuously. Review of the resident’s comprehensive care plans found no care plan developed to address the use and need for oxygen therapy. During observations on 12/03/2025 and 12/08/2025, Resident #24 was seen sitting in a wheelchair in the room with a nasal cannula in place and connected to an oxygen concentrator. During interviews, the RN Manager stated there should be a care plan for the resident’s oxygen therapy and that it should have been created when the physician’s order was entered into the electronic medical record. The DON stated the care plan should have been developed when the oxygen order was entered and that the nurse manager or nurse supervisor can update care plans.
Unqualified CNA Applied Wound Care and Used Soiled Towel on Uncovered Pressure Ulcers
Penalty
Summary
The facility did not ensure that each resident received treatment and care in accordance with professional standards of practice and the comprehensive person-centered care plan. This was identified for one resident reviewed for pressure ulcers, who was admitted with diagnoses including a non-pressure chronic ulcer of the left calf, peripheral vascular disease, and atrial fibrillation. The resident’s admission MDS documented a BIMS score of 15, indicating intact cognition, and the resident was at risk for pressure ulcers with one Stage 2 pressure ulcer present on admission. The resident was always continent of urine and occasionally incontinent of bowel. Physician’s orders dated 12/02/2025 directed topical application of medihoney wound dressing external gel to the bilateral buttocks and sacral area every day and during the evening after a normal saline cleanse followed by a silicone dressing shift. During observation, the resident was lying in bed with a 4 inch by 4 inch border gauze on the bedside table that had a white substance on it, and the resident stated the nurse left the gauze there for CNA #1 to apply after the bed bath. During morning care, CNA #1 provided a bed bath, but the resident’s pressure ulcers to the sacrum and buttocks were uncovered, and CNA #1 cleansed the uncovered pressure ulcers with a soiled towel that had been used to clean the resident’s genital area. CNA #1 stated they were not trained to do wound care and were only helping the nurses, while an LPN stated CNAs are not allowed to apply wound treatments. The DON stated only nurses are allowed to complete wound care treatments.
Failure to Obtain Timely Wound Care Orders for a Pressure Ulcer
Penalty
Summary
The facility did not ensure a resident with a pressure ulcer received necessary wound care services consistent with standards of practice to promote healing and prevent infection. Resident #98 was admitted on 11/26/2025 with diagnoses including peripheral vascular disease, atrial fibrillation, and a non-pressure chronic ulcer of the left calf, and the admission assessment documented a Stage 2 pressure ulcer on the right buttock that was present on admission. The resident’s MDS indicated intact cognition, and the resident was always continent of urine and occasionally incontinent of bowel. The admission/readmission evaluation documented the right buttock wound as a shallow open ulcer with loss of dermis and a red/pink wound bed. Although the care plan addressed risk for pressure injury development and included administering treatments and medications as ordered, there was no baseline care plan specific to the Stage 2 pressure ulcer. The physician’s orders from 11/26/2025 through 12/02/2025 contained weekly skin checks, but no wound care treatment orders were entered for the pressure ulcer during that period, and the TAR showed no treatments were provided to the wound. The wound care evaluation on 12/02/2025 documented the wound had progressed to a Stage 3 pressure ulcer measuring 2.3 cm by 2.9 cm by 0.1 cm with 100 percent granulation and light exudate, and treatment orders were then entered for daily wound care. Interviews revealed the admission nurse did not obtain a treatment order at admission, the wound care nurse stated the admission nurse should have notified the physician and obtained an order on 11/26/2025, and the primary care physician stated they assumed there was already a wound care order in place. The DON stated the resident should have received wound care treatments from admission and that the physician and nurses should have ensured a treatment order was in place.
Physician Oversight Missing for Admission Pressure Ulcer
Penalty
Summary
The facility did not ensure that the medical care of Resident #98 was supervised by a physician when a stage 2 pressure ulcer to the right buttock was identified on admission. The resident was admitted with diagnoses including a non-pressure chronic ulcer of the left calf, peripheral vascular disease, and atrial fibrillation, and the admission MDS documented intact cognition with a BIMS score of 15. The admission/readmission evaluation on 11/26/2025 documented a shallow open ulcer with loss of dermis and a red/pink wound bed on the right buttock, and the care plan addressed risk for pressure injury development, but there was no baseline care plan specific to the stage 2 pressure ulcer. The physician's orders dated 11/26/2025 included weekly skin checks, but a review of orders from 11/26/2025 through 12/02/2025 showed no wound care treatment orders for the pressure ulcer, and the TAR showed no treatments were provided during that period. The physician visit note on 11/29/2025 documented the right buttock ulcer but did not include treatment recommendations. The wound care evaluation on 12/02/2025 documented the ulcer as stage 3, measuring 2.3 cm by 2.9 cm by 0.1 cm with 100 percent granulation and light exudate, and treatment orders for medihoney and dressing changes were entered that day. During interviews, the wound care nurse stated there was no physician order for treatment until the resident was assessed on 12/02/2025, and the primary care physician stated they assumed there was an order in place and acknowledged responsibility for ensuring one existed.
CNA Failed to Report Resident Toe Injury
Penalty
Summary
The facility did not ensure that nurse aides demonstrated the competencies needed to care for residents, as shown by one resident’s left great toe injury that was not reported to nursing staff. Resident #1 had diagnoses including peripheral vascular disease and diabetes mellitus, and a 5-Day MDS documented a BIMS score of 13, indicating intact cognition. The resident was dependent on staff for bed mobility and transfers and could propel themself in a wheelchair once seated. During observation, the resident was seen sitting on the side of the bed with feet on the floor and no socks on, and a hematoma was observed on the left great toenail. The resident stated that someone rolled over the toe with a wheelchair during a music program, but could not provide the date and time of the incident. Certified Nursing Assistant #2 stated they cared for the resident and saw discoloration on the left great toe, but did not report it to the nurse because the resident was not complaining of pain and the regular nurse was not on duty. The CNA stated they did not think it was a big deal, but later acknowledged they should have reported the injury. The CNA task record for skin observation contained no documentation of the toe discoloration. An LPN stated they were not made aware of the discoloration, and the DON stated the CNA should have reported the change in skin condition to the nurse and that it was not the CNA’s responsibility to decide what was a big deal.
Unlabeled refused medication stored in medication cart
Penalty
Summary
All drugs and biologicals were not stored in locked compartments as required. During the recertification survey, surveyors observed an unlabeled souffle cup containing one tablet of Januvia 25 mg in the top drawer of the Unit 2 North B medication cart. The medication cart was one of four units reviewed during the medication storage task, and the tablet had been placed in the cart after a refused dose rather than being discarded. Licensed Practical Nurse #3 confirmed that Resident #49 refused the 06:00 AM Januvia dose and that the medication was stored in the cart in an unlabeled souffle cup instead of being discarded. Resident #49 had diagnoses including type 2 diabetes mellitus, chronic obstructive pulmonary disease, and heart failure, and the quarterly MDS documented a BIMS score of 10, indicating moderately impaired cognition. The physician’s order directed Januvia 25 mg by mouth once daily for diabetes mellitus. During the observation, the top drawer of the B medication cart contained the souffle cup with one orange tablet, and the December 2025 MAR documented that Resident #49 received the Januvia dose on 12/04/2025. The LPN stated the tablet should have been discarded and should not have been placed back in the medication cart, and the RN supervisor and DON both stated the refused medication should have been discarded rather than stored in an unlabeled souffle cup.
Therapeutic Diet Orders Not Followed on Meal Trays
Penalty
Summary
Resident #206 had physician orders for a no added salt diet with mechanically altered chopped texture and thin liquids related to heart failure, and the care plan documented the resident as high nutrition/hydration risk with interventions to provide a no added salt diet as prescribed. The resident also had diagnoses including heart failure, hypertension, and ulcerative colitis, and the MDS documented moderate cognitive impairment. During interviews, the resident stated they were supposed to be on a no added salt diet but were receiving incorrect meals and sometimes did not eat because of the salt in the meals. During meal observations, Resident #206 was served breakfast and lunch trays that matched a regular mechanically altered chopped diet and included salt packets, despite the physician order for no added salt. The resident stated they did not use the salt packets and did not know why they were receiving them. Staff interviews showed dietary staff transcribed diet orders onto meal tickets, CNAs checked meal tickets for tray items but did not verify the prescribed diet, and the dietitian reviewed physician orders in the meal ticket system only quarterly and was unsure why the meal ticket did not match the physician order. The PCP stated the dietary staff should have followed the no added salt order and should not have provided a regular diet with salt packets.
Unlabeled Tube Feedings and Improper Cold Food Temperatures
Penalty
Summary
Food was not prepared, distributed, and served in accordance with professional standards for food service safety. During the recertification survey, two residents receiving tube feedings were found with enteral feeding formula and water bags that were not labeled with the resident’s name, date, and time the feeding was initiated. The facility policy titled Enteral Feeding Tubes and Care stated that feeding solution is hung for no longer than 24 hours and that the feeding set is changed and labeled with the patient’s name, date, and time every 24 hours. One resident had dysphagia following a cerebral infarction, intact cognition with a BIMS score of 15, and received nutrition and fluids by tube feeding. The resident’s care plan directed tube feeding, water flushes, and head-of-bed positioning during feeding. The physician’s order specified Osmolite 1.5 at 83 mL per hour with automatic water flushes starting at 5:00 PM until completed. During observation, the enteral feeding bottle and water bag were hanging without a label showing the resident’s name and the time the feeding was started, and the resident was not receiving the feeding at that moment. Staff interviews reflected that the feeding and water bags should have been labeled, although one nurse stated the labels had been placed before the feeding began. The second resident had dysphagia, moderate cognitive impairment with a BIMS score of 11, and received nutrition and hydration through a feeding tube. The resident’s care plan and physician’s orders directed continuous tube feeding with Pivot 1.5 and automatic water flushes. During observation, the resident’s tube feeding pump was connected to a formula bag and a water bag that were both unlabeled and undated. In addition, during tray line service observation, cold food items were measured above the facility’s required 41 degrees Fahrenheit limit, including almond milk at 52.9 degrees Fahrenheit and yogurt at 59.6 degrees Fahrenheit. The Food Service Director stated the cold food temperatures were not appropriate and that cold food held above 41 degrees Fahrenheit increases the risk for foodborne illness.
Infection Control Failure During Wound Care
Penalty
Summary
The facility did not maintain an infection prevention and control program to help prevent the transmission of communicable diseases and infections. During the recertification survey, Resident #98 was observed receiving morning care while lying in bed. The resident had stage 3 pressure ulcers on the sacrum, left buttock, and right buttock, and the resident was admitted with diagnoses including a non-pressure chronic ulcer of the left calf, peripheral vascular disease, and atrial fibrillation. The admission MDS documented a BIMS score of 15, indicating intact cognition, and the resident was at risk for pressure ulcers with one stage 2 pressure ulcer present on admission. Physician orders directed daily and evening topical wound treatment to the bilateral buttocks and sacral area after a normal saline cleanse. During the morning care observation, the resident's pressure ulcers were uncovered, and CNA #1 cleansed the wounds with a soiled towel that had been used to clean the resident's genital area. A border gauze with a white substance was also observed on the bedside table, and the resident stated the nurse had left it there for CNA #1 to apply after the bed bath. CNA #1 stated that some nurses leave wound care treatment for CNAs to apply after bathing, while LPN #6 stated CNAs are not allowed to apply wound care because they are not qualified. The wound care nurse and the DON both stated that only licensed nurses are allowed to complete wound care treatments, and the wound care nurse stated the soiled towel should not have contacted the resident's wounds.
Food Storage and Hand Hygiene Deficiencies
Penalty
Summary
The facility did not ensure that food was stored, prepared, distributed, and served in accordance with professional standards for food service safety. During an initial tour of the kitchen, surveyors observed opened and undated packages of food in the walk-in freezer and refrigerator, debris and food spills in the walk-in refrigerators and freezer, and multiple food preparation surfaces with built-up food residue. Additionally, racks for can storage were found to have a layer of dust. Follow-up tours revealed further issues, including uncovered and undated raw burger patties, dirty racks containing food, and food residue and grease buildup under worktables. Interviews with the Food Service Director and Assistant Food Service Director confirmed that there were lapses in cleaning and food storage protocols, and that there was no cleaning schedule in place despite daily and special cleaning assignments being mentioned. The facility also failed to adhere to proper hand hygiene practices during meal service. During a dining observation, a Therapeutic Recreation Aide was seen touching a garbage can and then opening food containers on a resident's tray without performing hand hygiene. The same aide then served another meal tray without washing their hands. Additionally, a Registered Nurse Education Coordinator was observed fixing their hair and then setting up a resident meal tray without performing hand hygiene. Both staff members acknowledged that they should have performed hand hygiene before handling the meal trays. These deficiencies were identified during the Recertification survey, which was initiated on 5/1/2024 and completed on 5/9/2024. The facility's policies and procedures for cleaning, food storage, and hand hygiene were not followed, leading to unsanitary conditions in the kitchen and improper hand hygiene practices during meal service. These lapses were confirmed through observations, record reviews, and staff interviews.
Resident's Right to Make Choices Not Ensured
Penalty
Summary
The facility did not ensure that Resident #82 had the right to make choices about aspects of their life in the facility that were significant to them. Specifically, the facility did not allow Resident #82 to have access to outside food brought in by their family member. Despite the resident's cognitive impairment, the physician's evaluation indicated that Resident #82 was competent to make informed medical decisions. The resident had a history of noncompliance with dietary restrictions and preferred ordering takeout from pizzerias and fast food restaurants. The facility's policy required educating the resident and family about proper food safety and modifying food consistency to comply with diet orders, but the facility chose to confiscate and return the food brought by the family member instead. Interviews with the Registered Dietician, Social Worker, and Director of Nursing Services revealed that the facility had repeatedly educated the resident and their family about the dietary restrictions and the importance of adhering to the prescribed diet. Despite these efforts, the resident continued to be non-compliant, and the facility decided to send the food back with the family member. The Social Worker and Director of Nursing Services believed that the facility did not violate the resident's rights, even though the resident expressed upset over being denied access to the food brought by their family member.
Significant Medication Error in Insulin Administration
Penalty
Summary
The facility did not ensure that residents were free from significant medication errors, as observed during the Recertification Survey. Specifically, a Licensed Practical Nurse (LPN) administered the wrong type of insulin to a resident with severely impaired cognition. The resident, who had a documented blood sugar level of 137 milligrams per deciliter, was supposed to receive Semglee-insulin Glargine, a long-acting insulin, but instead received 10 units of Admelog insulin, a fast-acting insulin that should have been held if the blood sugar level was below 300 milligrams per deciliter. This error was identified during a medication pass observation and confirmed through record review and interviews with the involved staff and medical personnel. The facility's policy for insulin administration, which requires verification of the type, strength, and method of administration with the physician's order, was not followed. The LPN admitted to the error, stating that they were late in administering the insulin due to providing care to other residents. The Director of Nursing Services and the Medical Doctor both confirmed that the resident received the wrong type of insulin, which could potentially harm the resident. The incident highlights a significant lapse in medication administration protocols within the facility.
Sanitation and Pest Control Deficiency
Penalty
Summary
The facility did not provide a sanitary and comfortable environment for residents, staff, and the public. During the Recertification Survey, four live roaches, one dead roach, and one unidentified crushed insect were observed in the first-floor conference room. Additionally, the kitchen shelf where Styrofoam cups were stored had a heavy accumulation of dust and debris beneath it. The facility's Pest Control policy, dated 10/18/2022, documented an ongoing pest management program, but observations indicated that the program was not effectively implemented. On 5/1/2024, roaches were found floating in coffee served to the survey team, which was believed to have originated from the cups supplied by the facility kitchen. Pest Management Service Inspection Report Records from 5/3/2023 to 4/28/2024 showed multiple instances of roach activity and crawling bugs, with recommendations for better sanitation practices in the kitchen to prevent insect intrusion. Further inspection on 5/1/2024 revealed that the coffee/hot water urns in the kitchen had an accumulation of dust and were not cleaned properly by the incoming shift. The dry storage area where the Styrofoam cups were stored also had a heavy accumulation of dust and debris. Additionally, a cabinet below the coffee urns in the conference room contained one unidentified crushed insect and one dead roach in a glue trap. The Administrator was informed of these findings and stated that the glue trap was placed by the pest control company, denying any previous observations of roaches. Despite the facility's pest control policy, the presence of insects and poor sanitation practices were evident, leading to the deficiency.
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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 St James
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Luxor Nursing & Rehabilitation At Mills Pond | 0 mi | ★★★★★ | 0 | 0 |
| Smithtown Center For Rehabilitation & Nursing Care | 1.6 mi | ★★★★★ | 3 | 0 |
| The Hamlet Rehabilitation And Healthcare Center At | 2.2 mi | ★★★★★ | 0 | 0 |
| Long Island State Veterans Home | 2.5 mi | ★★★★★ | 0 | 0 |
| Brookside Multicare Nursing Center | 3.2 mi | ★★★★★ | 3 | 0 |
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