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 The Willows At Ramapo Rehab And Nursing Center during CMS and state inspections, most recent first.
A resident with intact cognition and diagnoses including amputations, CHF, and DM was restricted to withdrawing personal funds only on two days a week and in small amounts, despite facility policy stating residents must have 24/7 access to their money. Staff reported the resident was limited to $10 twice weekly, sometimes $15, and had been refused on other days, while the resident said they wanted more money available for vending machine purchases and had been turned away when requesting withdrawals.
Soiled Wheelchairs Observed for Two Residents: Two residents with significant cognitive and physical impairments were observed sitting in visibly soiled wheelchairs. One wheelchair had dry dirt caked on the frame and cushion, with soiled gauze around the leg rest attachments; the other had a white dried substance on the wheel spokes and side, a stained cushion corner, and dusty grime on the frame. Staff stated wheelchair cleaning was scheduled but inconsistent, not tracked, and often done only when soiling was noticed.
Failure to Provide Required Eating Assistance: Two residents with documented need for maximal or moderate assist with eating were observed receiving mostly set-up only or minimal help during meals. One resident had MS, dysphagia, dementia, and significant wt loss, while the other had dementia, severe protein-calorie malnutrition, dysphasia, and wt loss. Staff observations showed poor intake, untouched or inaccessible food items, and limited encouragement or hands-on feeding despite care plan and MDS requirements.
A resident with dementia and a high fall risk had a care plan calling for a well-lit, clutter-free environment, yet floor mats previously identified as a tripping hazard were still present in the room and observed folded against the wall. Staff confirmed the mats were for the resident, while the unit manager stated they had been discontinued because they were a tripping hazard.
Oxygen was not provided at the ordered rate for a resident with COPD, dysphagia, and Alzheimer’s disease. The resident’s order specified 2 L/min via NC continuously, but surveyors observed the concentrator running at 3 L/min while the resident was sleeping in bed on multiple occasions. An LPN acknowledged the oxygen was running above the ordered rate and stated the flow level was not checked during med pass, and the ADON confirmed staff needed to follow the physician’s order.
A resident with cognitive intactness, depression symptoms, and later socially inappropriate and aggressive behaviors made an inappropriate sexual comment to another resident. The MD ordered psychiatry and psychology consults, and the care plan included behavioral health interventions, but the RN UM and DON could not locate any consult notes in the EMR, and the psychology consultant confirmed the resident had not been requested for evaluation until later.
Food was not stored in accordance with professional standards during the survey. Multiple food items in the snack refrigerator, portable tray rack, and freezer were observed without proper identification, including fruit cups, cottage cheese cups, pudding cups, peanut butter cups, mixed vegetables, and lettuce. A dietary cook was also observed slicing chicken breasts without wearing a beard net, and the Dietary Supervisor stated that food needed to be labeled, dated, and that staff were to wear hair and beard nets if needed.
A resident with severe cognitive impairment and multiple medical conditions did not receive required ADL assistance, turning, and safety checks as documented in their care plan. The assigned CNA failed to provide care or transfer the resident to bed, and documentation was falsified. The resident was later found on the floor with injuries and was pronounced deceased. Staff interviews and video evidence confirmed lapses in care, communication, and supervision, resulting in actual harm.
A resident with severe cognitive impairment and multiple medical conditions was documented as having received ADL care by a CNA who reported not providing or recording such care. Additionally, an LPN documented hourly rounding for the resident after the resident had expired and was removed from the facility. These actions resulted in inaccurate medical records, contrary to professional standards.
Staff failed to consistently wear gowns while providing hands-on care to a resident on enhanced barrier precautions, despite clear signage and facility policy. Multiple staff, including a respiratory therapist and a nurse manager, provided direct care with only gloves, even when the resident was minimally clothed and diaphoretic. Interviews revealed lapses in awareness and adherence to infection control protocols among staff.
A resident with a history of accusatory behaviors required a two-person assist for care, but the care plan was not updated in the CNA documentation. This oversight led to a CNA providing care alone, resulting in an alleged abuse incident. The facility failed to ensure timely updates and communication of the care plan to all staff.
The facility failed to ensure food safety and proper storage, with issues including a soiled chest freezer, unlabeled ground beef, missing cooling logs, and nourishment refrigerators not maintained at safe temperatures. Additionally, food service staff did not follow safe food handling practices.
A resident with Multiple Sclerosis and optic neuritis was not provided with opportunities to participate in independent activities of their choice, despite their preferences being documented. The Activities staff did not visit the resident, and there was no evidence of participation in activities since February 2023.
A resident with severe cognitive impairment and multiple diagnoses was not provided soft booties as recommended by physical therapy to prevent contractures and pressure sores. The care plan and CNA task reports lacked directives for their use, and observations confirmed the resident was not wearing the booties on multiple occasions.
A resident with severe cognitive impairment and respiratory failure did not receive continuous oxygen therapy as ordered. The resident was observed multiple times without the nasal cannula, and staff did not ensure the oxygen saturation rate was maintained as required.
Restriction of Resident Access to Personal Funds
Penalty
Summary
The facility did not ensure it acted as a fiduciary for Resident #29’s personal funds by restricting access to the resident’s money to only two days a week and limiting withdrawals to amounts lower than the resident wanted. Resident #29 had diagnoses including a left below-the-knee amputation, partial right foot amputation, congestive heart failure, and diabetes, and the quarterly MDS documented intact cognition. The facility policy stated residents must have access to personal funds 24 hours a day, seven days a week, but staff told surveyors the resident was limited to $10 twice a week, sometimes $15, and had been refused when requesting money on other days. The resident’s family member had requested limits on how much money the resident could withdraw and how often, but the resident’s family member was listed only as an emergency contact and not as power of attorney. Staff interviews showed the Business Office Manager, receptionist, and social worker were involved in the restriction, while the Administrator stated no one was restricted and was not aware of any restriction on Resident #29’s account. The resident stated they had been turned away on days other than Tuesday and Friday, wanted more money available each week, and said not being able to get money when desired upset them. The resident’s personal fund records showed a balance over $1,000 and repeated withdrawals of $10 or $15 from the account.
Soiled Wheelchairs Observed for Two Residents
Penalty
Summary
The facility did not ensure two residents’ right to a safe, clean, comfortable, and homelike environment because their wheelchairs were visibly soiled. Resident #126, who had dementia, dysphagia, muscle weakness, severely impaired cognition, and was dependent on staff for transfers, was observed sitting in a wheelchair with dry dirt caked on the frame and cushion. On a later observation, the resident was again sitting in the wheelchair, and the protective white gauze wrapped where the leg rests attach bilaterally was visibly soiled and light brown in color. Resident #170, who had unspecified psychosis, dysphagia, cerebral ischemia, severely impaired cognition, and required moderate assistance for transfers, was observed sitting in a wheelchair with a white dried substance on the right wheel spokes and right side of the wheelchair up to the back rest. The right corner of the cushion was visibly stained, and there was dusty grime on the wheelchair frame. Staff interviews indicated wheelchairs were supposed to be cleaned on a schedule, but the process was inconsistent, not tracked, and soiled wheelchairs were cleaned as needed when noticed.
Failure to Provide Required Eating Assistance
Penalty
Summary
The facility did not ensure that residents who were unable to perform activities of daily living independently received the level of assistance with eating that was documented in their care plans and assessments. The facility policy stated that residents unable to carry out ADLs independently were to receive appropriate support and assistance with dining, including meals and snacks. During the survey, two residents were identified as not receiving the assistance they required during meals despite documented needs for maximal or moderate assistance. Resident #128 had diagnoses including multiple sclerosis, dysphagia, and dementia, and the Significant Change MDS documented severely impaired cognition, maximal assistance with eating, and significant weight loss. The care plan and current CNA Kardex both documented maximal assistance with eating. The resident’s weight decreased from 161 pounds in October 2025 to 135 pounds in March 2026, a 16% loss. During multiple lunch observations, the resident was seen picking at food, struggling to drink from a cup, and eating only small portions of the meal, while staff provided no observed assistance beyond asking if the resident wanted to eat more when the tray was being removed. Resident #140 had diagnoses including dementia, severe protein calorie malnutrition, and dysphasia, and the Quarterly MDS documented severely impaired cognition and moderate assistance with eating. The care plan and CNA Kardex also documented moderate assistance with eating. The resident’s weight decreased from 124 pounds in October 2025 to 120 pounds in March 2026. During observations, the resident was seen playing with utensils and wrappers, leaving food untouched, and having sealed items remain inaccessible, while staff provided little or no assistance or encouragement until late in the meal or when the tray was being removed. Staff interviews reflected differing understandings of the resident’s needs, with one CNA stating the resident only required set-up assistance, while the Director of Rehabilitation and the Dietician stated that the resident required moderate assistance and encouragement with eating.
Unsafe Use of Floor Mats for a High-Fall-Risk Resident
Penalty
Summary
The facility did not ensure that Resident #72’s environment remained as free of accident hazards as possible. Resident #72 had diagnoses including dementia, obstructive uropathy, and cerebral ischemia, and was assessed as high risk for falls with risk factors including prior falls, antihypertensive use, impaired memory recall, total incontinence, and inability to independently stand. The resident’s care plan included interventions such as keeping the environment well lit and free of clutter, and the resident also had a history of actual falls documented in the record. Although floor mats had previously been identified as a tripping hazard and were documented as removed from both sides of the bed, floor mats were still observed in the resident’s room during the survey. One mat was seen folded up and leaning against the wall by the bed, and later two mats were observed folded up against the wall on the resident’s side of the room. Staff stated the mats were for Resident #72 and were in the room, while the unit manager stated the mats should not have been in the room or in use because they had been discontinued as a tripping hazard.
Oxygen Administered Above Ordered Flow Rate
Penalty
Summary
Provide safe and appropriate respiratory care for a resident when needed was not ensured for Resident #69. The resident had diagnoses including dysphagia following other cerebrovascular disease, Alzheimer's disease, and chronic obstructive pulmonary disease. The quarterly MDS documented severe cognitive impairment, shortness of breath when lying flat, and oxygen therapy. A physician order dated 03/03/2026 directed oxygen at 2 liters via nasal cannula continuously every shift for COPD, and the care plan addressed oxygen therapy related to ineffective gas exchange with interventions including administering medications as ordered. During observations on 03/08/2026, 03/09/2026, and 03/12/2026, Resident #69 was found sleeping in bed with oxygen being administered via nasal cannula while the oxygen concentrator was running at 3 liters/minute. On 03/12/2026, an LPN stated the concentrator was administering between 3 and 4 liters/minute and acknowledged the ordered rate was 2 liters per minute, adding that oxygen concentration levels were not checked during medication pass earlier in the shift and should have been. The ADON later stated physician orders needed to be followed for oxygen administration and confirmed the order was for 2 liters/minute.
Failure to Complete Ordered Behavioral Health Consults
Penalty
Summary
The facility did not ensure a resident received necessary behavioral health services in accordance with the comprehensive assessment and plan of care. Resident #9 had diagnoses including displaced intertrochanteric fracture of the left femur, bilateral osteoarthritis of the hip, and hypertension, and the admission MDS documented the resident was cognitively intact, reported feeling down, depressed, and hopeless several days, and had no behaviors, hallucinations, or rejection of care. A physician order documented psychology consult and follow up as needed, and the care plan identified a potential psychosocial well-being problem with interventions including pastoral care, social services, and psychological services. After Resident #9 made an inappropriate sexual comment to another resident, nursing documented that the resident was redirected, social services were notified, and the physician was notified with a plan for psychiatry follow-up. The care plan was updated to note socially inappropriate behavior, including making sexual comments to another resident, with interventions for enhanced monitoring and psychiatric and psychology evaluation as needed. Additional nursing notes documented episodes of upset, refusal to attend a pulmonary appointment, and aggressive behavior when staff intervened while the resident was speaking with another resident. During interviews, the RN Unit Manager stated the physician requested psychiatry and psychology consults after the sexual comment, but no psychiatry or psychology consult note could be located in the EMR from that time to the survey date. The DON also stated they were unaware whether Resident #9 had been seen by psychiatry or psychology and could not locate a consult note. The psychology consultant stated routine consults are usually completed within 24 to 48 hours or immediately for crisis residents, but Resident #9 had not been requested for consultation until the day of the interview, and the consultant confirmed no request had been made previously.
Improper Food Labeling and Beard Net Use
Penalty
Summary
Food was not stored in accordance with professional standards for food service safety during the recertification survey. During the kitchen inspection with the Dietary Supervisor, six food items were observed without proper identification in the snack refrigerator, portable tray rack, and freezer, including trays of apple and pineapple cups, cottage cheese cups, apples in cups, oranges in cups, pudding cups, peanut butter cups, a bag of mixed vegetables not in its original container, and five plates of lettuce. The facility policy titled Food Receiving and Storage, last approved 09/12/2025, documented that refrigerated foods are to be labeled, dated, and monitored. In addition, a dietary cook was observed leaning over and slicing chicken breasts without wearing a beard net, and the cook stated they knew they were supposed to wear one but had forgotten that morning. The Dietary Supervisor stated that food needed to be labeled, dated, and that all staff were to wear hair and beard nets if needed.
Failure to Provide Required ADL Assistance and Supervision Resulting in Resident Harm
Penalty
Summary
A deficiency occurred when a resident with severe cognitive impairment, dependence for activities of daily living (ADLs), and multiple medical conditions including pneumonia, coronary artery disease, heart failure, and a stage two pressure ulcer, did not receive required care and assistance as outlined in their care plan. The care plan specified frequent turning and repositioning, assistance with toileting and dressing, and regular safety checks, particularly due to the resident's incontinence, oxygen therapy, and pressure ulcer. On the evening in question, video surveillance and documentation review revealed that the assigned Certified Nurse Aide (CNA) did not provide the necessary care, including transferring the resident to bed, changing clothing, or performing safety checks, despite documentation indicating otherwise. The resident was last seen in their wheelchair, fully clothed, and not in bed as was their usual routine. Staff interviews and video evidence confirmed that no staff entered the resident's room for an extended period during the evening shift. The resident was later found on the floor, face down between the bed and wheelchair, with their oxygen cannula dislodged and sustaining lacerations to the forehead and neck. The resident was non-verbal, short of breath, and subsequently pronounced deceased at the facility. The incident investigation determined that the resident experienced a medical event leading to a fall, and due to their condition, was unable to get up or call for help, resulting in further injury. Interviews with staff revealed lapses in communication and assignment handoff, with the CNA stating they did not receive a report or assignment sheet and did not provide care to the resident. The LPN on duty acknowledged noticing the resident was not changed or in bed but did not follow up to ensure care was provided after instructing the CNA. Other staff and the resident's family confirmed that the resident was typically in bed early in the evening and always required assistance. The failure to provide care and supervision as required by the care plan resulted in actual harm to the resident.
Inaccurate Documentation of Resident Care and Rounding After Resident Death
Penalty
Summary
The facility failed to maintain accurate and professional documentation of medical records for one resident reviewed for activities of daily living (ADL) care. Specifically, a Certified Nurse Aide (CNA) was documented in the electronic medical record as having provided ADL care to a resident on a certain date, but the CNA stated during interview that they did not provide care to the resident on that date, nor did they enter the documentation. The CNA also indicated that the resident's name was not on their assignment sheet. The facility's Director of Nursing confirmed that CNAs are instructed not to share their passwords and that documentation should only be completed by the assigned CNA using their unique credentials. Additionally, a Licensed Practical Nurse (LPN) documented hourly rounding for the same resident from late evening through early morning, including times after the resident had expired and their remains had been removed from the facility. The LPN stated that documentation was started later in the shift due to an incident and police presence, and acknowledged that the resident's name should have been removed from the rounding sheet after death. The Director of Nursing confirmed that the resident was removed from the unit by the Medical Examiner and was unable to explain why documentation continued after the resident's removal. These actions resulted in inaccurate and incomplete medical records, not in accordance with accepted professional standards.
Failure to Adhere to Enhanced Barrier Precautions During Resident Care
Penalty
Summary
During a complaint investigation, surveyors identified that the facility failed to maintain infection prevention and control practices in accordance with its own policy for enhanced barrier precautions for one resident. The resident in question had multiple active diagnoses, including sepsis, chronic osteomyelitis, gastrostomy malfunction, and several unhealed pressure ulcers, and was under enhanced barrier precautions as indicated by signage outside their room. The resident's care plan and medical orders specifically required the use of enhanced barrier precautions, including gown and glove use during high-contact care activities. On three separate occasions, staff members provided hands-on care to the resident without wearing gowns, despite the posted signage and facility policy. Observations included a respiratory therapist adjusting respiratory equipment and physically assisting the resident while only wearing gloves, and a registered nurse manager assisting with changing the resident's gown without donning a new gown after having removed it to leave the room. The resident was noted to be diaphoretic and minimally clothed during these interactions, increasing the likelihood of direct contact with bodily fluids and skin. Interviews with the involved staff revealed a lack of awareness or lapses in adherence to the enhanced barrier precautions policy. The respiratory therapist, who was new to the facility, did not notice the signage and believed a gown was unnecessary for auscultating breath sounds. The registered nurse manager was unaware that a gown was required upon returning to the bedside, and the LPN acknowledged noticing the lapse but did not intervene. Leadership staff, including the DON and medical director, confirmed that gowns are required for all hands-on care for residents on enhanced barrier precautions, regardless of the specific task.
Failure to Update Care Plan Leads to Alleged Abuse Incident
Penalty
Summary
The facility failed to ensure that the comprehensive care plans were reviewed and revised in a timely manner for a resident with a history of accusatory behaviors. The resident, who was diagnosed with depression, paranoid schizophrenia, and morbid obesity, required a two-person assist for all care due to their behavioral symptoms, which included verbal aggression and accusations towards staff. However, the care plan was not updated to reflect this requirement in the Certified Nurse Aide (CNA) documentation, leading to a CNA providing care alone without the necessary assistance. On January 7, 2024, the resident accused a CNA of alleged abuse after care was provided without a second staff member present. The CNA was unaware of the two-person assist requirement because it was not documented in the CNA Kardex. The Assistant Director of Nursing and the Director of Nursing confirmed that the care plan was not properly updated to include the two-person assist requirement in the CNA documentation, which was a critical oversight. The incident highlights a failure in the facility's process for updating and communicating care plans to all relevant staff. The care plan, initiated in April 2022, was not revised to include the necessary interventions for CNAs until after the incident occurred. This lack of timely updates and communication led to the CNA being unaware of the resident's specific care needs, resulting in the alleged incident.
Food Safety and Storage 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, a chest freezer used as a refrigerated unit was found to be heavily soiled with various colored grime and mold. The Food Service Director (FSD) admitted that the freezer was not in a sanitary condition for food storage. Additionally, a walk-in refrigerated unit contained a heavily soiled grocery bag and unlabeled, defrosted ground beef, which the FSD could not confirm was safe to eat and subsequently decided to discard. The FSD also failed to produce cooling logs for meatloaf prepared the previous week, indicating a lack of proper documentation and monitoring of food cooling processes. Further observations revealed that two nourishment refrigerators were not maintained at safe temperatures for food safety. The Team 7 refrigerator had a thermometer reading of 45 degrees Fahrenheit, while the Team 3 refrigerator had a reading of 46 degrees Fahrenheit. Both refrigerators contained various food items, including meatloaf, yogurt, pudding, and milk, with temperatures exceeding safe limits. The FSD acknowledged the issue and decided to discard the foods and inform maintenance and administration. Additionally, during meal service, two food service staff members did not follow safe food handling practices while recording food temperatures. One cook was observed sanitizing a thermometer probe with gloves that had touched unsanitary surfaces, and the FSD assisted by handling alcohol wipes with bare hands. These deficiencies highlight significant lapses in food safety practices within the facility, including improper storage, inadequate temperature control, and poor hygiene practices by food service staff. The FSD's inconsistent statements and inability to provide necessary documentation further underscore the lack of adherence to professional standards for food service safety.
Failure to Provide Ongoing Activities Program
Penalty
Summary
The facility did not provide an ongoing program of activities for a resident diagnosed with Multiple Sclerosis and optic neuritis. The resident, who was cognitively intact and had expressed preferences for daily activities such as music, keeping up with the news, and getting fresh air, was not consistently provided opportunities to participate in independent activities of their choice. The resident's Care Plan, which was updated in April 2023, documented a preference for self-directed activities and included interventions to encourage these activities. However, observations and interviews revealed that the resident was not visited by Activities staff and did not have any activities in their room. The Director of Activities confirmed that the resident had expressed a preference not to attend group activities and preferred to watch TV and movies in their room. Despite this, the Director was unable to provide evidence of the resident's participation in independent activities since February 2023. This lack of documentation and follow-through on the resident's preferences led to the deficiency noted in the survey report.
Failure to Provide Appropriate ROM Treatment
Penalty
Summary
The facility did not ensure that a resident was provided the appropriate treatment to improve and/or prevent a further decline in range of motion (ROM). Specifically, a resident with diagnoses including encephalopathy, stroke, and generalized muscle weakness was not provided soft booties as recommended by physical therapy. The resident's care plan did not include the use of soft booties or monitoring their effects, despite a physical therapy evaluation and discharge summary indicating the necessity of soft booties to prevent pressure sores and contractures. Observations revealed that the resident was not wearing the soft booties on multiple occasions, and there was no documented evidence in the physician's orders or CNA task reports directing their use. Interviews with the Director of Rehabilitation confirmed that the resident was referred to the rehabilitation department due to contracture of the bilateral ankles and that soft booties were to be used at all times to maintain neutral alignment of the ankles. However, the review of the resident's chart revealed no physician's order, care plan documentation, or CNA task assignment directing the use of soft booties. This deficiency was identified during the recertification survey and was based on observations, record reviews, and interviews.
Failure to Provide Continuous Oxygen Therapy
Penalty
Summary
The facility failed to ensure that Resident #82 received continuous oxygen therapy as per the physician's order of 3L/min via nasal cannula. The resident, who had diagnoses including cerebral infarction, respiratory failure, and anxiety, was observed multiple times without the nasal cannula in place. On 11/14/2023 at 01:38 PM, the resident was seen in their wheelchair without the nasal cannula, with the oxygen tubing and cannula by the nightstand. Again, at 03:20 PM the same day, the resident was observed sleeping in the wheelchair without the nasal cannula, which was found on the floor by the nightstand table near the window. The oxygen concentrator was on during both observations. On 11/15/2023 at 09:59 AM, the resident was again seen without the nasal cannula, with the tubing wrapped around the tube feeding pole and the cannula in the nightstand drawer. During an interview on 11/15/2023 at 09:29 AM, the physician stated that the oxygen was intended to maintain the resident's saturation rate and that staff were expected to check the oxygen saturation rate if the resident removed the oxygen, ensuring it remained above 88%. An LPN interviewed on 11/15/2023 at 10:08 AM confirmed that staff would check the oxygen saturation level and consult with the nurse manager if a resident removed their oxygen to ensure the resident's well-being.
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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 Suffern
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Northern Metropolitan Res Health Care Facility Inc | 3.2 mi | ★★★★★ | 2 | 0 |
| Allendale Rehabilitation And Healthcare Center | 4 mi | ★★★★★ | 12 | 0 |
| Woodcliff Lake Health & Rehabilitation Center | 4.9 mi | ★★★★★ | 0 | 0 |
| Pine Valley Center For Rehabilitation And Nursing | 5.2 mi | ★★★★★ | 13 | 0 |
| Friedwald Center For Rehab And Nursing, L L C | 5.9 mi | ★★★★★ | 4 | 0 |
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