Above average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
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 The Hamlet Rehabilitation And Healthcare Center At during CMS and state inspections, most recent first.
During a survey, it was found that egress doors with delayed egress locks lacked the required signage on the door leaf, as per NFPA 101 standards. Instead, the signage was placed on adjacent walls, which does not comply with the regulations. The Director of Maintenance acknowledged the issue and planned to correct it.
A resident with a Stage 4 pressure ulcer did not receive appropriate wound care as per professional standards. The wound care team recommended using normal saline instead of Dakin's solution, but the physician's order was not updated in a timely manner. This led to a delay in implementing the recommended treatment, highlighting a communication lapse among the care team.
A resident with a PICC line did not receive appropriate monitoring and documentation of the catheter's external length and site condition, as required by facility policy. The facility failed to ensure physician's orders included necessary assessments for infection and catheter migration, leading to a deficiency in care.
A resident with COPD did not receive adequate oxygen therapy due to an empty oxygen tank, despite having a physician's order for oxygen at 2 liters per minute as needed. The facility's policy lacked clarity on monitoring responsibilities, and staff failed to check the tank regularly, leading to low oxygen saturation levels.
Improper Signage Placement on Egress Doors
Penalty
Summary
During a recertification survey, it was observed that egress doors equipped with delayed egress locking mechanisms did not have the required signage as per NFPA 101 standards. The signage, which should be located on the door leaf adjacent to the release device in the direction of egress, was instead installed on the walls adjacent to the egress doors. This placement does not comply with the specified requirements for visibility and accessibility in emergency situations. The deficiency was identified during the Life Code survey conducted on February 12, 2025, between 9:00 AM and 3:00 PM. In a subsequent interview on February 13, 2025, the Director of Maintenance acknowledged the issue and stated that the appropriate egress signages would be ordered and installed on the egress doors. The lack of proper signage could potentially hinder the effectiveness of the delayed egress locking mechanisms in an emergency.
Plan Of Correction
Plan of Correction: Approved March 11, 2025 I. Corrective Immediate Action The Director of Plant Operations has ordered ICON construction company that is still under contract, to order and install Emergency Egress signage on newly installed fire exit doors, that is ADA compliant, on all emergency fire doors on all units including the basement to comply with: 2012 NFPA 101: 19.2.2.2.4, 7.2.1.6.1.1 10NYCRR 711.2(a)(1) II. Identification of Other Areas a. A visual observation has been made by the Director of Plant Operations to identify areas of the facility that may be affected by the same practice. b. All areas that have been affected by the same practice have been noted and communicated to the contractor for immediate remediation. III. Education The Director of Plant Operations will in-service the maintenance staff as to the requirements of 2012 NFPA 101: 19.2.2.2.4, 7.2.1.6.1.1, 10NYCRR 711.2(a)(1) to identify and prevent future practices of this type. IV. QA Monitoring The Director of Plant Operations/Designee will monitor practices and record findings during weekly fire door/emergency egress preventive maintenance/life safety rounds monthly for the next 6 months. Logs will be kept in the Maintenance Director’s Office. Any negative findings will be immediately brought to the Director of Plant Operations for remediation. The Plant Operations Director will bring any negative findings to the QAPI committee monthly. V. Person Responsible for Corrective Action Director of Plant Operations
Failure to Implement Wound Care Recommendations
Penalty
Summary
The facility failed to ensure that a resident with pressure ulcers received necessary treatment and services consistent with professional standards to promote healing and prevent infections. This deficiency was identified for a resident with a Stage 4 pressure ulcer on the left buttock and sacrum. The resident had a physician's order to cleanse the wound with Dakin's solution, but the wound care nurse used sodium chloride solution instead during a wound care observation. Although the wound care team recommended using normal saline instead of Dakin's solution, there was no documented evidence that this recommendation was implemented until several days later. The facility's policy required that recommendations made by wound care providers be reviewed and addressed by primary care providers within 48 hours. However, the physician's order for the resident's wound care was not updated to reflect the wound care team's recommendation to use normal saline. During a wound care observation, the wound care nurse realized the discrepancy and acknowledged that they should have checked the physician's orders before starting treatment and obtained a new order to use normal saline. Interviews with various staff members, including the wound care nurse, LPNs, and the wound care nurse practitioner, revealed a lack of communication and documentation regarding the change in wound care treatment. The wound care nurse practitioner had recommended discontinuing the use of Dakin's solution due to the absence of infection signs and the potential for skin damage with prolonged use. However, the recommendation was not communicated to the primary physician in a timely manner, resulting in a delay in updating the treatment orders.
Plan Of Correction
Plan of Correction: Approved March 14, 2025 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** I. Resident #11’s physicians orders were reviewed by the medical provider on 2/18/25. The Medical provider agreed with the wound care provider’s recommendation to change the Dakin’s solution for cleaning the wound to normal saline. The physician’s order was reconciled and placed in the electronic medical record by the resident’s MD on 2/18/25. The Wound Care Nurse was provided with education regarding following physician orders, prior to start of a pressure injury treatment, that includes a physician’s orders administration competency. II. All residents with pressure injury have the potential to be affected by the same deficient practice. On this date, 3/10/25, there are a total number of 14 out of 223 residents who currently have pressure injury. All 14 residents’ wound care rounds recommendations by the Wound Care team were reviewed by the DNS and reconciled with the medical provider on 3/14/25. III. The Pressure Injury and Physician order [REDACTED]. The Wound Care Nurse Practitioner will be re-educated to provide all recommendations timely to the medical provider within 48 hours of consult by the Medical Director. A Wound Care Recommendation form was created by the DNS to facilitate communication between the wound care team and the MD. The DNS and/or designee will monitor pressure ulcer treatment recommendations to ensure all new recommendations have been addressed and reconciled with the attending physician. All licensed nursing staff will be re-educated by the Staff Educator regarding following physician orders [REDACTED]. All licensed nurses will complete a physician’s orders administration competency post education. All licensed nurses will receive education regarding the Wound Care Recommendation form by the Staff Educator. IV. The DNS and/or designee will conduct 5-10 treatment observations weekly for four weeks and then monthly for six months. The DNS and/or designee will review the Wound Care Recommendation form weekly for four weeks and then monthly for six months for compliance. Findings from both audits will be brought to QAPI monthly for review and discussion by the DNS and/or designee. V. The Director of Nursing will be responsible for compliance.
Deficiency in PICC Line Monitoring and Documentation
Penalty
Summary
The facility failed to ensure the safe and appropriate administration of intravenous fluids for a resident with a Peripherally Inserted Central Catheter (PICC). Resident #323, who was admitted with a PICC line in the left upper arm, did not have documented evidence of routine measurement of the external length of the catheter to prevent migration. Additionally, the care plan was not updated to include this measurement, and the physician's order lacked instructions for monitoring the catheter site for signs of infection and measuring the external length with each dressing change. The facility's policy required that the external length of the PICC be measured with each dressing change and that the site be assessed for signs of infection, complications, or dislodgement. However, from February 6 to February 14 and February 18 to February 19, there was no documentation of these assessments in the resident's Medication Administration Record and Treatment Administration Record. Observations and interviews revealed that the nursing staff, including the Assistant Director of Nursing Services and Registered Nurse #1, were unaware of the policy requirements for monitoring the catheter for migration and measuring its external length. Interviews with the Director of Nursing Services and Physician #1 indicated that the medical team was responsible for ensuring appropriate orders were in place upon admission, but this was not done. The Director of Nursing Services acknowledged the absence of physician's orders addressing the assessment of the catheter site for infection and measurement of the external length. This oversight led to a deficiency in the care provided to Resident #323, as the necessary monitoring and documentation were not conducted according to professional standards and facility policy.
Plan Of Correction
Plan of Correction: Approved March 14, 2025 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** I. Resident #323 discharged home on [DATE]. MD orders for PICC line site dressing was changed to measure the external length of the catheter, the arm circumference, and to monitor the site for redness, swelling or tenderness on 2/19/25 for Resident #323. II. All residents with PICC lines have the potential to be affected by the same deficient practice. On this date, 3/10/25, there are a total number of 1 out of 223 residents who currently have PICC lines. Residents with PICC line orders have been reviewed to ensure that dressing change orders include monitoring the circumference of the arm, the length of the external catheter, and to monitor for any redness, tenderness and swelling, as well as checking that the dressing is clean, dry and intact. III. The PICC Line and Physician order [REDACTED]. All attending physicians and extenders will be educated to ensure that orders are in place for the care of the Peripherally Inserted Central Catheter, including to measure the external length of the catheter for residents who have orders for PICC lines by the Medical Director. All licensed nursing staff will be re-educated by the Staff Educator regarding PICC Lines and Physician Orders, to include the nurses to document the catheter site monitoring and measurements of the external catheter length and arm circumference with each dressing change. All licensed nurses will also be educated to notify the MD if the measurements vary from the original measurements at time of placement. All licensed nurses will complete a physician’s orders administration and PICC line competency post education. IV. All residents who have PICC lines will be audited by the ADNS and/or designee weekly for one month and monthly for 6 months thereafter. The audit will include documentation of the catheter site monitoring and measurements of the external catheter length with each dressing change. Findings will be brought to the DNS weekly and then brought to QAPI monthly for review and discussion by the DNS and/or designee. V. The Director of Nursing will be responsible for compliance.
Failure to Ensure Adequate Oxygen Supply for Resident with COPD
Penalty
Summary
The facility failed to provide appropriate respiratory care for a resident with Chronic Obstructive Pulmonary Disease (COPD), as required by professional standards and the resident's care plan. The resident had a physician's order for oxygen therapy at 2 liters per minute via a nasal cannula as needed for shortness of breath. During an observation, the resident was found attempting to use an empty oxygen tank, resulting in low oxygen saturation levels between 88 to 91 percent, which is below the normal range. The Director of Nursing Services confirmed the tank was empty and replaced it, which improved the resident's oxygen saturation level. The deficiency was further highlighted by the facility's Oxygen Administration Policy, which did not specify who was responsible for monitoring the oxygen tanks. Interviews with staff revealed that the resident had been using an oxygen tank due to a broken concentrator, and the tank was not checked regularly to ensure it had sufficient oxygen. A Licensed Practical Nurse admitted to not checking the tank after 9:00 AM, despite knowing it was only a quarter full. The Nurse Practitioner emphasized the importance of following physician orders for oxygen therapy, especially given the resident's significant COPD diagnosis.
Plan Of Correction
Plan of Correction: Approved March 10, 2025 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** I. Resident #7’s oxygen tank was immediately replaced with an oxygen concentrator by the DNS on 2/12/25. Resident #7’s oxygen saturation level was checked by using pulse oximetry and was between 88-92% (the resident has a [DIAGNOSES REDACTED]. Licensed Practical Nurse #4 was educated to monitor oxygen tank levels. She was educated that tanks below ? of a tank should be replaced with a new tank if an oxygen concentrator is not available. LPN #4 was also educated that residents who receive oxygen therapy should have oxygen concentrators placed in their rooms, if available, for their use while in their room. II. All residents with orders for oxygen therapy have the potential to be affected by the same deficient practice. On this date, 3/10/25, there are a total number of 15 out of 223 residents who currently have orders for oxygen. All residents who receive oxygen in their rooms have been provided with an oxygen concentrator. III. The Oxygen Administration policy was reviewed and revised on 3/10/25 by the DNS, Medical Director, and Administrator. The revision includes: 1. licensed nursing staff is responsible to monitor oxygen tanks; 2. oxygen concentrators will be provided in resident rooms, if available, for residents receiving oxygen therapy. All licensed nursing staff will be educated by the Staff Educator on the revision of the Oxygen Administration policy regarding oxygen tank replacement if at a ? of a tank and to provide oxygen concentrators in resident rooms if available to residents receiving oxygen therapy. All licensed nurses will complete an Oxygen Administration competency post education. The Unit Manager and/or designee will round weekly to ensure residents with oxygen administration orders have an oxygen concentrator in their room, if available. IV. 5-7 residents who have oxygen administration orders will be audited to ensure the oxygen tank in use is above a ? of a tank and/or an oxygen concentrator is available bedside by the Unit Manager and/or designee weekly for one month and monthly for 6 months thereafter. Findings will be brought to the DNS weekly and then brought to QAPI monthly for review and discussion by the DNS and/or designee. V. The Director of Nursing will be responsible for compliance.
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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 Nesconset
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Smithtown Center For Rehabilitation & Nursing Care | 1.7 mi | ★★★★★ | 3 | 0 |
| Brookside Multicare Nursing Center | 1.9 mi | ★★★★★ | 3 | 0 |
| St Catherine Of Siena Nrsg And Rehab Care Center | 2 mi | ★★★★★ | 5 | 0 |
| St James Rehabilitation & Healthcare Center | 2.2 mi | ★★★★★ | 10 | 0 |
| Luxor Nursing & Rehabilitation At Mills Pond | 2.2 mi | ★★★★★ | 0 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.