General Information: TEN BROECK COMMONS
Nursing home name TEN BROECK COMMONS
AddressONE COMMONS DRIVE
LAKE KATRINE, NY 12449
Phone number (845) 336-6666
Located within a hospital No
Type of ownership For profit - Corporation
Owner operates multiple homesNo
Accept Medicare or Medicaid Medicare and Medicaid
Continue Care Retirement CommunityNo
Resident and family councils Both
Certified number of beds 258
Total number of residents 254
Perc of occupied beds 98
Sprinkler status Yes
Number of Facility Reported Incidents0
Number of Substantiated Complaints0
Number of Fines0
Total Amount of Fines$0
Total Number of Penalties0
Total Number of Penalties0
Ratings Summary: TEN BROECK COMMONS
Overall rating 4
4
Nursing Home Staffing 2
2
Registered Nurses only 2
2
Health Inspections 4
4
Quality Measures 4
4
Nursing Home Staffing Info: TEN BROECK COMMONS
National AverageNew York AverageTEN BROECK COMMONS
Overall staff rating NA NA 2
2
Registered Nurses only rating NANA 2
2
Total Number of Residents NA NA 254
Total Number of Nurse Staff Hours per Resident per Day 4.11 hours 3.95 hours 3.65 hours
Total Number of Licensed Nurse Staff Hours per Resident per Day 1.64 hours 1.56 hours 1.31 hours
Registered Nurses Hours per Residents per Day 0.81 hours 0.72 hours 0.49 hours
Licensed Practical or Vacation Nurses Hours per Resident per Day 0.83 hours 0.84 hours 0.82 hours
Certified Nursing Assistants Hours per Residents per Day 2.47 hours 2.39 hours 2.34 hours
Physical Therapy Staffing Hours per Resident Per Day 0.1 hours 0.1 hours 0.05 hours
Health Survey: TEN BROECK COMMONS
Heath Survey Summary on 2013-09-05
Total Number of Health Deficiencies 1
Scope and Severity of most Severe Health Deficiency Pattern/Minimal harm or potential for actual harm
Heath Survey Summary on 2012-06-27
Total Number of Health Deficiencies 3
Scope and Severity of most Severe Health Deficiency Isolated/Minimal harm or potential for actual harm
Heath Survey Summary on 2011-07-05
Total Number of Health Deficiencies 10
Scope and Severity of most Severe Health Deficiency Isolated/Minimal harm or potential for actual harm
Health Survey Details: TEN BROECK COMMONS
Inspection Results: 09/05/2013
Corrected Deficiency Scope and Severity
09/09/2013 Store, cook, and serve food in a safe and clean way. Pattern/Minimal harm or potential for actual harm
Inspection Results: 06/27/2012
Corrected Deficiency Scope and Severity
08/24/2012 Allow residents to self-administer drugs if determined safe. Isolated/Minimal harm or potential for actual harm
08/24/2012 Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Isolated/Minimal harm or potential for actual harm
08/24/2012 Ensure that each resident who enters the nursing home without a catheter is not given a catheter, unless medically necessary, and that incontinent patients receive proper services to prevent urinary tract infections and restore normal bladder functions. Isolated/Minimal harm or potential for actual harm
Inspection Results: 07/05/2011
Corrected Deficiency Scope and Severity
08/12/2011 Provide a safe, clean, comfortable and home-like environment; and allow residents to use personal belongings to the extent possible. Pattern/Potential for minimal harm
08/12/2011 Allow residents the right to participate in the planning or revision of care and treatment. Isolated/Minimal harm or potential for actual harm
08/12/2011 Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. Isolated/Minimal harm or potential for actual harm
08/12/2011 Ensure residents have the right to have a choice over activities, their schedules, and health care according to their interests, assessments, and plans of care. Pattern/Potential for minimal harm
08/12/2011 Provide care for residents in a way that maintains or improves their dignity and respect in full recognition of their individuality. Isolated/Minimal harm or potential for actual harm
08/12/2011 Develop and implement policies for 1) screening and training employees; and the 2) prevention, identification, investigation, and reporting of any abuse, neglect, mistreatment and misappropriation of property. Isolated/Minimal harm or potential for actual harm
08/12/2011 Ensure that each resident's 1) entire drug/medication regimen is free from unnecessary drugs; and 2) is managed and monitored to achieve highest level of well-being. Isolated/Minimal harm or potential for actual harm
08/12/2011 At least once a month, have a licensed pharmacist review each resident's medication(s) and report any irregularities to the attending doctor. Isolated/Minimal harm or potential for actual harm
08/12/2011 Have a program that investigates, controls and keeps infection from spreading. Isolated/Minimal harm or potential for actual harm
08/12/2011 Provide at least one room set aside to use as a resident dining room and for activities, that is a good size, with good lighting, air flow and furniture. Isolated/Minimal harm or potential for actual harm

Fire Safety Survey: TEN BROECK COMMONS
Fire Safety Survey Summary on 2013-09-05
Total Number of Fire SafetyDeficiencies 0
Scope and Severity of most Severe Health Deficiency
Fire Safety Survey Summary on 2012-06-27
Total Number of Fire SafetyDeficiencies 0
Scope and Severity of most Severe Health Deficiency
Fire Safety Survey Summary on 2011-07-05
Total Number of Fire SafetyDeficiencies 0
Scope and Severity of most Severe Health Deficiency
Fire Safety Survey: TEN BROECK COMMONS
Not available

Resident Complaints: TEN BROECK COMMONS
Not available

Quality Measures: TEN BROECK COMMONS
Quality Measures National Average New York Average TEN BROECK COMMONS
Overall quality rating NA NA 4
4
Long-Stay Residents
Percent of Long Stay Residents Whose Need for Help with ADLs has Increased 15.4% 14.3% 13.0%
Percent of Long Stay Residents Who Self Report Moderate to Severe Pain 8.3% 5.9% 5.6%
Percent of High Risk Long Stay Residents With Pressure Ulcers 6.1% 7.7% 4.6%
Percent of Long Stay Residents Who Lose Too Much Weight 7.2% 6.3% 6.6%
Percent of Low Risk Long Stay Residents Who Lose Control of Their Bowel or Bladder 43.9% 44.4% 49.8%
Percent of Long Stay Residents with a Catheter Inserted and Left in Their Bladder 3.2% 2.7% 4.8%
Percent of Long Stay Residents With a Urinary Tract Infection 6.2% 5.8% 4.6%
Percent of Long Stay Residents Who Have Depressive Symptoms 6.3% 11.6% 6.6%
Percent of Long Stay Residents Who Were Physically Restrained 1.4% 1.8% 6.7%
Percent of Long Stay Residents Experiencing One or More Falls with Major Injury 3.2% 2.7% 2.4%
Percent of Long Stay Residents Assessed and Appropriately Given the Seasonal Influenza Vaccine 92.7% 93.9% 97.8%
Percent of Long Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine 94.3% 96.9% 98.7%
Percent of Long Stay Residents Who Received an Antipsychotic Medication 20.7% 18.7% 17.0%
Short-Stay Residents
Percent of Short Stay Residents Who Self Report Moderate to Severe Pain 19.2% 14.6% 10.1%
Percent of Short Stay Residents With Pressure Ulcers That Are New or Worsened 1.2% 1.2% 1.2%
Percent of Short Stay Residents Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine 83.4% 83.1% 93.9%
Percent of Short Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine 82.4% 83.8% 94.3%
Percent of Short Stay Residents Who Newly Received an Antipsychotic Medication 2.6% 2.4% 0.5%

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