5 health deficiencies
Top issue: Resident Rights (2 deficiencies)
17 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (7 deficiencies)
Bronx, NY
4-star overall rating with 4-star inspections with 5 recent health deficiencies with 17 fire-safety deficiencies in the latest cycle
1265 Fulton Avenue, Bronx, NY
(718) 579-7000
Overall
4 / 5
CMS overall stars
Health inspections
4 / 5
Survey and complaint cycles
Staffing
2 / 5
RN + nurse staffing
Quality measures
3 / 5
Resident outcomes and process measures
Quick facts
Beds
240
Certified beds
Average residents
226
Average occupied residents
Ownership
Non-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
1991-09-13
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Staffing
RN hours / resident day
0.46
Registered nurse staffing
LPN hours / resident day
0.39
Licensed practical nurse staffing
Aide hours / resident day
1.82
Nurse aide staffing
Weekend hours
2.11
Weekend nurse staffing
RN turnover
15%
Annual RN turnover
Total nurse turnover
24%
Annual nurse turnover
Quality measures
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.6 |
1.7
0.1 pts better
|
1.9
0.3 pts better
|
Long Stay · 20240701-20250630 |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 2.0 |
1.3
0.7 pts worse
|
1.8
0.2 pts worse
|
Long Stay · 20240701-20250630 |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 69.9% |
91.2%
21.3 pts worse
|
93.4%
23.5 pts worse
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 87.9% |
95.3%
7.4 pts worse
|
95.5%
7.6 pts worse
|
Long Stay · 2024Q3-2025Q2 |
| Percentage of long-stay residents experiencing one or more falls with major injury | 1.4% |
3.0%
1.6 pts better
|
3.3%
1.9 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents who have depressive symptoms | 0.5% |
18.5%
18 pts better
|
11.4%
10.9 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents who lose too much weight | 4.3% |
6.1%
1.8 pts better
|
5.4%
1.1 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 7.6% |
13.5%
5.9 pts better
|
19.6%
12 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents who received an antipsychotic medication | 15.6% |
14.8%
0.8 pts worse
|
16.7%
1.1 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents who were physically restrained | 0.2% |
0.2%
About the same
|
0.1%
0.1 pts worse
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents whose ability to walk independently worsened | 32.9% |
15.1%
17.8 pts worse
|
16.3%
16.6 pts worse
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents whose need for help with daily activities has increased | 26.0% |
15.5%
10.5 pts worse
|
14.9%
11.1 pts worse
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.8% |
0.6%
0.2 pts worse
|
1.0%
0.2 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents with a urinary tract infection | 0.9% |
1.4%
0.5 pts better
|
1.7%
0.8 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 6.7% |
20.8%
14.1 pts better
|
19.8%
13.1 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents with pressure ulcers | 6.1% |
6.9%
0.8 pts better
|
5.1%
1 pts worse
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 25.4% |
76.7%
51.3 pts worse
|
81.7%
56.3 pts worse
|
Short Stay · 2024Q4-2025Q3 |
| Percentage of short-stay residents who had an outpatient emergency department visit | 7.2% |
9.7%
2.5 pts better
|
12.0%
4.8 pts better
|
Short Stay · 20240701-20250630 |
| Percentage of short-stay residents who newly received an antipsychotic medication | 3.1% |
1.2%
1.9 pts worse
|
1.6%
1.5 pts worse
|
Short Stay · 2024Q4-2025Q3 |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 26.4% |
78.8%
52.4 pts worse
|
79.7%
53.3 pts worse
|
Short Stay · 2024Q3-2025Q2 |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 13.3% |
20.6%
7.3 pts better
|
23.9%
10.6 pts better
|
Short Stay · 20240701-20250630 |
Survey summary
Top issue: Resident Rights (2 deficiencies)
17 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (7 deficiencies)
Top issue: Resident Rights (3 deficiencies)
9 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (3 deficiencies)
Top issue: Freedom from Abuse and Neglect and Exploitation (3 deficiencies)
1 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)
Fire safety
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2025-10-03
Fire Safety
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Corrected 2025-10-03
Fire Safety
Install an approved automatic sprinkler system.
Corrected 2025-10-03
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2025-10-03
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2025-10-03
Fire Safety
Meet requirements for the installation and maintenance of electrical systems.
Corrected 2025-10-03
Fire Safety
Have power receptacles that are properly grounded.
Corrected 2025-10-03
Fire Safety
Have proper power supply for life support equipment.
Corrected 2025-12-10
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2025-12-08
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2025-10-03
Fire Safety
Have exits that are accessible at all times.
Corrected 2025-10-03
Fire Safety
Install proper backup exit lighting.
Corrected 2025-10-03
Fire Safety
Have properly located and lighted "Exit" signs.
Corrected 2025-10-03
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2025-10-03
Fire Safety
Properly select, install, inspect, or maintain portable fire extinguishes.
Corrected 2025-10-03
Fire Safety
Ensure gas and vacuum piping is labeled.
Corrected 2025-10-03
Fire Safety
Have proper medical gas storage and administration areas.
Corrected 2025-10-03
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2023-08-08
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2023-08-08
Fire Safety
Ensure that testing and maintenance of electrical equipment is performed.
Corrected 2023-08-08
Fire Safety
Have exits that are accessible at all times.
Corrected 2023-08-08
Fire Safety
Construct fire resistant interior walls.
Corrected 2023-08-08
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2023-08-08
Fire Safety
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Corrected 2023-08-08
Fire Safety
Have proper power supply for life support equipment.
Corrected 2023-08-08
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2023-08-08
Fire Safety
Have proper power supply for life support equipment.
Corrected 2021-01-26
Inspection history
Health
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Corrected 2025-10-03
Health
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2025-10-03
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2025-10-03
Health
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected 2025-10-03
Health
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Corrected 2025-10-03
Health
Assure the security of all personal funds of residents deposited with the facility.
Corrected 2023-06-30
Health
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Corrected 2023-06-30
Health
Allow resident to participate in the development and implementation of his or her person-centered plan of care.
Corrected 2023-06-30
Health
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Corrected 2023-06-30
Health
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected 2023-06-30
Health
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Corrected 2023-06-30
Health
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected 2023-06-30
Health
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected 2023-06-30
Health
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2020-12-01
Health
Respond appropriately to all alleged violations.
Corrected 2020-12-01
Penalties and ownership
Corporate Director · Individual
Corporate Officer · Individual
Corporate Director · Individual
Corporate Officer · Individual
W-2 Managing Employee · Individual
Corporate Director · Individual
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