Below 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 Westchester Center For Rehabilitation & Nursing during CMS and state inspections, most recent first.
A resident with severe cognitive impairment was involved in an aggressive incident requiring psychiatric evaluation, but the family was not promptly notified as required by facility policy. The family only learned of the event during a visit, and documentation and staff interviews confirmed the delay in communication.
A resident with multiple chronic conditions and moderate cognitive impairment was not provided with quarterly statements of their personal funds, and was unaware of their account or deductions made for services. The facility could not provide documentation that the resident received required financial statements, and its policy lacked a process for distributing these statements.
Two residents in an LTC facility experienced significant incidents due to inadequate supervision and monitoring. One resident with a history of suicidal attempts was found with a wrist laceration and later harmed themselves with a pencil, despite being on 1:1 monitoring. Another resident with severe cognitive impairment and a history of falls sustained a head injury from an unwitnessed fall, with no documented care plan interventions or therapy evaluations after previous falls. The facility failed to adhere to its policy on incident investigation and monitoring.
A resident on comfort care with metastatic cancer and other conditions did not have their family's preferences incorporated into the pain management plan. The family requested morphine, but the physician suggested Lidocaine patches instead, without proper documentation or follow-up. Communication lapses among staff and with the family led to unmet expectations and a deficiency in person-centered care.
A resident on comfort care with serious health conditions did not receive appropriate pain management. Despite family requests for morphine, the facility failed to document consistent pain assessments or provide the requested medication. Instead, a lidocaine patch was offered and refused. Communication lapses among staff and the primary physician contributed to the deficiency.
A resident reported being shoved by a CNA during an incident involving the operation of an overhead light. The resident, who was cognitively intact and independent, described the shove as significant and reported ongoing issues with staff, particularly during the night shift. The facility's abuse prevention policy prohibits such mistreatment, and the CNA was terminated. However, the abuse was deemed unsubstantiated due to a lack of evidence.
Two residents reported abuse by staff, but the facility failed to complete investigations or report to the state. One resident alleged being shoved by a CNA, while another reported being pinched by an LPN. The facility did not document investigations or submit required reports, and the LPN continued to provide care until the survey. Interviews revealed non-compliance with abuse prevention protocols.
A facility failed to update a resident's care plan following an alleged abuse incident. The resident, who was cognitively intact and independent, had a history of anxiety and was at risk for abuse. Despite this, the care plan was not revised to reflect the incident. Interviews with staff revealed that the responsibility to update the care plan was not fulfilled, as the previous social worker had left the facility and the incident was not documented.
A resident with dementia and unsteadiness was identified as a medium fall risk but lacked documented safety measures or assistive devices, leading to a fall causing a wrist fracture and eye laceration. Despite the facility's policy requiring individualized care plans for fall prevention, necessary interventions were not documented or implemented.
Failure to Timely Notify Resident Representative of Incident
Penalty
Summary
A deficiency occurred when the facility failed to notify a resident's representative in a timely manner following an incident involving the resident. The resident, who had diagnoses including dementia, legal blindness, and cellulitis, and was assessed as having severely impaired cognition, was involved in an aggressive altercation with staff that resulted in the need for psychiatric evaluation. The incident was documented in the facility's records, but the notification to the family was not completed promptly. The family only became aware of the event when they visited the resident, who was visibly upset, and learned about the incident directly from the resident and staff present at the time. The facility's policy required immediate notification of the resident's representative in the event of an accident or incident. However, the incident report did not include a date or time for family notification, and staff interviews revealed uncertainty about whether and when the family was contacted. The family expressed concern during a subsequent meeting, stating they were not informed about the incident until their visit. The lack of timely communication was confirmed through interviews with staff and review of grievance documentation.
Failure to Provide Resident with Quarterly Financial Statements
Penalty
Summary
The facility failed to ensure that a resident's financial records were made available through quarterly statements, as required. Specifically, a resident with diagnoses including Diabetes Mellitus, End Stage Renal Disease, and Non-Alzheimer's Dementia was not aware of having any personal funds and denied receiving any financial statements. Review of the resident's fund ledger confirmed that the facility managed the resident's funds and that there were transactions, such as automatic deductions for barber services, from the account. Interviews with the Fiscal Manager revealed that while quarterly statements were reportedly hand-delivered to alert and oriented residents, there was no documented evidence that this resident received their statements. The Fiscal Manager was unable to provide proof of receipt or distribution of the statements to the resident and acknowledged uncertainty about the resident's awareness of their personal funds or the deductions made for services. The facility's policy on resident funds did not include a process for providing quarterly statements to residents.
Inadequate Supervision and Monitoring Leads to Resident Harm
Penalty
Summary
The facility failed to provide adequate supervision and monitoring to prevent accidents for two residents, leading to significant incidents. Resident #3, with a history of suicidal attempts, was found with a laceration on their left wrist on 05/04/2024, which was unwitnessed by staff. Despite being placed on 1:1 monitoring following the incident, there was no documented evidence of such monitoring. The resident was later found using a pencil to harm themselves and was transferred to the hospital. Interviews with staff revealed a lack of awareness of the resident's suicidal history and the interventions in place, indicating a failure in communication and documentation. Resident #10, who had severe cognitive impairment and a history of multiple falls, sustained a head injury from an unwitnessed fall on 10/09/2024. Despite multiple falls occurring earlier in the year, there was no documented evidence of appropriate care plan interventions to prevent further falls, nor were there any Physical Therapy or Occupational Therapy evaluations conducted after each fall. The resident was identified as high risk for falls, yet no comprehensive care plan was in place to address this risk. The facility's policy on incident and accident investigation was not adhered to, as evidenced by the lack of documented monitoring and care plan interventions for both residents. The Director of Nursing and other staff members were unaware of the specific interventions required for Resident #3, and there was no follow-up on Resident #10's falls to adjust their care plan. This lack of adherence to policy and inadequate communication among staff contributed to the deficiencies observed during the survey.
Failure to Incorporate Family in Pain Management Planning
Penalty
Summary
The facility failed to ensure that a resident's preferences were incorporated into the care plan goals, specifically regarding pain management for a resident placed on comfort care. The facility's policy on pain management emphasizes the inclusion of residents and their families in care planning, but this was not adhered to in the case of a resident with metastatic cancer, end-stage renal disease, and diabetes. The resident was placed on comfort care, and the family was not adequately involved in the pain management planning process. The resident's family requested morphine for pain management, but the primary physician did not document any discussion about ordering morphine and instead suggested Lidocaine patches, which the family refused. The physician did not follow up with the family due to being busy and on call at multiple facilities. The lack of communication and documentation led to confusion and unmet expectations regarding the resident's pain management. Interviews with staff revealed a lack of awareness and communication about the family's requests and the physician's orders. The Director of Nursing was unaware of the family's request for morphine and the desire to speak with the physician. The facility's failure to involve the family in the care planning process and to communicate effectively with them and among staff members resulted in a deficiency in providing person-centered care for the resident.
Failure in Pain Management for Resident on Comfort Care
Penalty
Summary
The facility failed to provide appropriate pain management for a resident who was placed on comfort care. The resident, who had multiple serious health conditions including metastatic malignancy and end-stage renal disease, was readmitted with orders for Tylenol as needed for pain and regular pain assessments. However, when the resident was placed on comfort care, no new interventions for pain management were documented, despite the family's request for morphine due to the resident's pain. On two occasions, the family requested morphine for the resident's pain, but the facility did not document consistent pain assessments or provide the requested medication. Instead, a verbal order for a lidocaine patch was received, which the family refused. The primary physician was informed of the refusal and the family's request to speak with them, but the physician did not follow up due to being busy and on call at multiple facilities. Interviews with facility staff revealed a lack of communication and follow-through regarding the family's requests and the resident's pain management needs. The Director of Nursing was unaware of the family's request for morphine, and the Registered Nurse Supervisor did not escalate the issue appropriately. The facility's failure to address the resident's pain management needs while on comfort care was a significant deficiency.
Resident Abuse Incident Involving CNA
Penalty
Summary
The facility failed to ensure the resident's right to be free from abuse, as evidenced by an incident involving a resident who reported being physically shoved by a Certified Nurse Assistant (CNA). The incident occurred when the resident attempted to show the CNA how to operate the overhead light, resulting in the CNA shoving the resident with their shoulder onto the bed. The resident, who was cognitively intact and independent in activities of daily living, reported the incident, which was documented in the facility's incident report. The resident expressed concerns about ongoing issues with staff, particularly during the night shift, and described the shove as significant enough to provoke a report. The facility's abuse prevention policy, last revised in September 2022, prohibits mistreatment and abuse of residents by anyone, including staff. Despite the policy, the incident was reported, and the CNA involved was terminated. Interviews with the resident and staff, including the Director of Nursing and a Registered Nurse supervisor, confirmed the resident's account of the incident. However, the Assistant Director of Nursing concluded that the abuse was unsubstantiated due to a lack of evidence, such as video footage, as the incident occurred in the resident's room.
Failure to Investigate and Report Abuse Allegations
Penalty
Summary
The facility failed to ensure that allegations of abuse were thoroughly investigated and reported to the New York State Department of Health within the required timeframe. Specifically, two residents reported incidents of abuse by staff members, but the facility did not provide documentation of completed investigations or submit the necessary reports to the state. Resident #1 alleged that a Certified Nurse Aide shoved them while they were in their room, but the facility did not complete the incident report or provide evidence of reporting the incident to the Department of Health. Interviews with the Director of Nursing and the Assistant Director of Nursing revealed that although an investigation was initiated, the required 5-day report was not submitted, and there was confusion about the reporting process. Resident #4, who had a diagnosis of Alzheimer's, Dementia, and Delusional disorder, reported being pinched by an LPN, resulting in soreness. Despite the resident's complaint, the facility did not conduct a thorough investigation, as there were no interviews or assessments of other residents who were cared for by the LPN on the day of the incident. The LPN continued to provide care to the resident until the survey, and the facility did not provide evidence of a completed investigation or report to the state. Interviews with the Assistant Director of Nursing and the Director of Nursing indicated that the facility's protocol for handling such allegations was not followed, and the LPN was only removed from the unit during the onsite survey. The facility's failure to properly investigate and report these allegations of abuse highlights a significant deficiency in their abuse prevention and management practices. The lack of documentation and timely reporting to the state agency demonstrates non-compliance with state regulations and raises concerns about the facility's ability to protect residents from potential abuse. The facility's actions and inactions in these cases indicate a need for improved procedures and adherence to regulatory requirements to ensure resident safety and well-being.
Failure to Update Care Plan Following Alleged Abuse
Penalty
Summary
The facility failed to ensure that the comprehensive care plan for a resident was reviewed and revised following an allegation of abuse. Specifically, the care plan for a resident, who was cognitively intact and independent in activities of daily living, was not updated to reflect an incident of alleged abuse that occurred on February 20, 2023. The resident had a history of anxiety and was at risk for abuse or neglect, with interventions in place to encourage the ventilation of feelings. However, the care plan did not document the incident, and there were no updates made to the psychosocial care plan since its initiation. Interviews with facility staff revealed that the incident should have been documented in the abuse or psychosocial care plan by the previous social worker, who was no longer employed at the facility. The Director of Nursing and the Assistant Director of Nursing acknowledged that the care plans should have been updated as needed. Additionally, a Registered Nurse supervisor indicated that the person receiving the initial report of the allegation was responsible for initiating or updating the care plan, which was not done in this case.
Inadequate Fall Prevention Measures for Resident
Penalty
Summary
The facility failed to ensure adequate supervision and assistive devices to prevent accidents for a resident identified as a mild fall risk upon admission. There was no documented evidence of any safety measures or assistive devices in place for this resident, who subsequently experienced a fall resulting in a left wrist fracture and a laceration to the left eye. The facility's fall prevention policy requires residents to be assessed for risk factors upon admission, with an individualized care plan to be formulated to prevent accidents. However, this was not adequately implemented for the resident in question. The resident had diagnoses including dementia, unsteadiness on feet, and other lack of coordination, and was assessed as having severe cognitive impairment. Despite being identified as a medium fall risk, there was no documented evidence of specific safety measures or assistive devices in use to prevent falls. The resident was found to have a bed alarm in place, but no floor mat was present, and side rails were not up. The Director of Nursing stated that high-risk residents should have interventions such as floor mats, bed in the lowest position, and frequent checks, but these measures were not documented for this resident.
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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 Mount Vernon
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| The Wartburg Home | 0.8 mi | ★★★★★ | 0 | 0 |
| Laconia Nursing Home | 2 mi | ★★★★★ | 0 | 0 |
| Schaffer Extended Care Center | 2 mi | ★★★★★ | 0 | 0 |
| Sutton Park Center For Nursing And Rehabilitation | 2.1 mi | ★★★★★ | 3 | 0 |
| Split Rock Rehabilition And Health Care Center | 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.