Cheektowaga, NY

Elderwood At Cheektowaga

3-star overall rating with 3-star inspections with 9 recent health deficiencies with 4 fire-safety deficiencies in the latest cycle

225 Bennett Road, Cheektowaga, NY

(716) 681-9480

Compare this facility

Overall

3 / 5

CMS overall stars

Health inspections

3 / 5

Survey and complaint cycles

Staffing

3 / 5

RN + nurse staffing

Quality measures

4 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

172

Certified beds

Average residents

161

Average occupied residents

Ownership

For-Profit

Publicly displayed owner type

Chain

Elderwood

Operator or chain grouping

Approved since

1991-06-17

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Chain footprint

17 facilities

Chain averages 3 overall / 3 health / 2 staffing / 4 quality stars

Changed ownership

Within the last 12 months

Family council

Yes

Resident and family council reported

Sprinklers

Yes

Automatic sprinklers in all required areas

Staffing

Hours and turnover

RN hours / resident day

0.46

Registered nurse staffing · state 0.70 · national 0.68

LPN hours / resident day

0.86

Licensed practical nurse staffing · state 0.78 · national 0.87

Aide hours / resident day

2.16

Nurse aide staffing · state 2.20 · national 2.35

Total nurse hours

3.48

All reported nurse hours · state 3.65 · national 3.89

Licensed hours

1.32

RN + LPN hours · state 1.47 · national 1.54

Weekend hours

2.92

Weekend nurse staffing · state 3.16 · national 3.43

Weekend RN hours

0.17

Weekend registered nurse coverage · state 0.47 · national 0.47

Physical therapist

0.14

Reported PT staffing · state 0.11 · national 0.07

Adjusted RN hours

0.51

CMS adjusted RN staffing hours

Adjusted total hours

3.86

CMS adjusted total nurse staffing hours

Case-mix index

1.23

Higher values indicate more complex resident acuity

RN turnover

52%

Annual RN turnover · state 41% · national 45%

Total nurse turnover

52%

Annual nurse turnover · state 41% · national 46%

SNF VBP

Value-based purchasing

Program rank

7,105

Lower is better among SNFs in the FY 2026 VBP program.

Performance score

30.73

Composite VBP score used to determine payment impact.

Payment multiplier

0.9861

Above 1.000 increases Medicare payment; below 1.000 reduces it.

Program components

How the VBP score is built

Readmission

2.22

Baseline 19.87% · Performance 20.40% · Measure score 2.22 · Achievement 2.22 · Improvement 0

Healthcare-associated infections

3.27

Baseline 8.94% · Performance 7.45% · Measure score 3.27 · Achievement 1.28 · Improvement 3.27

Total nurse turnover

3.35

Baseline 50.91% · Performance 50.00% · Measure score 3.35 · Achievement 3.35 · Improvement 0

Adjusted total nurse staffing

3.45

Baseline 4.3 hours · Performance 4.06 hours · Measure score 3.45 · Achievement 3.45 · Improvement 0

SNF QRP

Medicare quality reporting measures

Measure	Facility	National	Note
Potentially preventable 30-day readmission	12.29%	10.72% 1.6 pts worse	No Different than the National Rate · Eligible stays 137 · Observed rate 13.87% · Lower 95% interval 9.17%
Discharge to community	44.46%	50.57% 6.1 pts worse	No Different than the National Rate · Eligible stays 133 · Observed rate 39.1% · Lower 95% interval 37.46%
Medicare spending per beneficiary	0.78	1.02 0.2 pts better
Drug regimen review with follow-up	100%	95.27% 4.7 pts better	Numerator 111 · Denominator 111
Falls with major injury	1.8%	0.77% 1 pts worse	Numerator 2 · Denominator 111
Discharge self-care score	48.19%	53.69% 5.5 pts worse	Numerator 40 · Denominator 83
Discharge mobility score	50.6%	50.94% 0.3 pts worse	Numerator 42 · Denominator 83
Pressure ulcers or injuries, new or worsened	6.31%	2.29% 4 pts worse	Numerator 7 · Denominator 111 · Adjusted rate 7.13%
Healthcare-associated infections requiring hospitalization	7.45%	7.12% 0.3 pts worse	No Different than the National Rate · Eligible stays 64 · Observed rate 7.81% · Lower 95% interval 4.73%
Staff COVID-19 vaccination coverage	8.03%	8.2% 0.2 pts worse	Numerator 29 · Denominator 361
Staff flu vaccination coverage	19.65%	42% 22.4 pts worse	Numerator 67 · Denominator 341
Discharge function score	53.01%	56.45% 3.4 pts worse	Numerator 44 · Denominator 83
Transfer of health information to provider	100%	95.95% 4 pts better	Numerator 28 · Denominator 28
Transfer of health information to patient	98.18%	96.28% 1.9 pts better	Numerator 54 · Denominator 55
Resident COVID-19 vaccinations up to date	18.18%	25.2% 7 pts worse	Numerator 10 · Denominator 55

Quality measures

Resident outcomes and process scores

Measure	Facility	State	National	Note
Number of hospitalizations per 1000 long-stay resident days	1.2	1.7 0.5 pts better	1.9 0.7 pts better	Long Stay · 20240701-20250630 · Adjusted 1.2 · Observed 1.1 · Expected 1.8 · Used in QM five-star
Number of outpatient emergency department visits per 1000 long-stay resident days	0.8	1.3 0.5 pts better	1.8 1 pts better	Long Stay · 20240701-20250630 · Adjusted 0.8 · Observed 0.8 · Expected 1.6 · Used in QM five-star
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine	91.3%	91.2% 0.1 pts better	93.4% 2.1 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 85.2% · Q2 82.1% · Q3 99.2% · Q4 98.5% · 4Q avg 91.3%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine	77.1%	95.3% 18.2 pts worse	95.5% 18.4 pts worse	Long Stay · 2024Q3-2025Q2 · 4Q avg 77.1%
Percentage of long-stay residents experiencing one or more falls with major injury	2.1%	3.0% 0.9 pts better	3.3% 1.2 pts better	Long Stay · 2024Q4-2025Q3 · Q1 1.6% · Q2 2.2% · Q3 1.6% · Q4 3.1% · 4Q avg 2.1% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms	1.2%	18.5% 17.3 pts better	11.4% 10.2 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.8% · Q2 0.0% · Q3 3.4% · Q4 0.8% · 4Q avg 1.2%
Percentage of long-stay residents who lose too much weight	11.1%	6.1% 5 pts worse	5.4% 5.7 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 12.6% · Q2 10.3% · Q3 7.7% · Q4 13.9% · 4Q avg 11.1%
Percentage of long-stay residents who received an antianxiety or hypnotic medication	15.3%	13.5% 1.8 pts worse	19.6% 4.3 pts better	Long Stay · 2024Q4-2025Q3 · Q1 14.5% · Q2 16.3% · Q3 15.4% · Q4 14.8% · 4Q avg 15.3%
Percentage of long-stay residents who received an antipsychotic medication	9.7%	14.8% 5.1 pts better	16.7% 7 pts better	Long Stay · 2024Q4-2025Q3 · Q1 9.0% · Q2 12.4% · Q3 8.5% · Q4 8.7% · 4Q avg 9.7% · Used in QM five-star
Percentage of long-stay residents who were physically restrained	0.0%	0.2% 0.2 pts better	0.1% 0.1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0%
Percentage of long-stay residents whose ability to walk independently worsened	25.6%	15.1% 10.5 pts worse	16.3% 9.3 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 21.3% · Q2 22.8% · Q3 24.7% · Q4 34.3% · 4Q avg 25.6% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased	23.6%	15.5% 8.1 pts worse	14.9% 8.7 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 20.5% · Q2 26.4% · Q3 24.6% · Q4 22.4% · 4Q avg 23.6% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder	0.6%	0.6% About the same	1.0% 0.4 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.7% · Q2 1.2% · Q3 0.6% · Q4 0.0% · 4Q avg 0.6% · Used in QM five-star
Percentage of long-stay residents with a urinary tract infection	0.6%	1.4% 0.8 pts better	1.7% 1.1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 2.5% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.6% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence	27.3%	20.8% 6.5 pts worse	19.8% 7.5 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 29.1% · Q2 31.9% · Q3 21.3% · Q4 26.9% · 4Q avg 27.3%
Percentage of long-stay residents with pressure ulcers	9.7%	6.9% 2.8 pts worse	5.1% 4.6 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 8.5% · Q2 10.7% · Q3 7.8% · Q4 11.5% · 4Q avg 9.7% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine	83.5%	76.7% 6.8 pts better	81.7% 1.8 pts better	Short Stay · 2024Q4-2025Q3 · Q1 72.8% · Q2 82.5% · Q3 91.4% · Q4 86.2% · 4Q avg 83.5%
Percentage of short-stay residents who had an outpatient emergency department visit	6.2%	9.7% 3.5 pts better	12.0% 5.8 pts better	Short Stay · 20240701-20250630 · Adjusted 6.2% · Observed 6.2% · Expected 11.3% · Used in QM five-star
Percentage of short-stay residents who newly received an antipsychotic medication	0.9%	1.2% 0.3 pts better	1.6% 0.7 pts better	Short Stay · 2024Q4-2025Q3 · Q1 1.4% · Q2 1.3% · Q3 0.7% · Q4 0.0% · 4Q avg 0.9% · Used in QM five-star
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine	76.6%	78.8% 2.2 pts worse	79.7% 3.1 pts worse	Short Stay · 2024Q3-2025Q2 · 4Q avg 76.6%
Percentage of short-stay residents who were rehospitalized after a nursing home admission	21.4%	20.6% 0.8 pts worse	23.9% 2.5 pts better	Short Stay · 20240701-20250630 · Adjusted 21.4% · Observed 20.0% · Expected 22.3% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2024-06-18 · Fire 2024-06-18

9 health deficiencies

Top issue: Resident Rights (3 deficiencies)

4 fire-safety deficiencies

Top issue: Smoke (2 deficiencies)

Cycle 2 Health 2022-10-03 · Fire 2022-10-03

3 health deficiencies

Top issue: Nutrition and Dietary (1 deficiency)

4 fire-safety deficiencies

Top issue: Gas and Vacuum and Electrical Systems (2 deficiencies)

Cycle 3 Health 2019-11-12 · Fire 2019-11-12

8 health deficiencies

Top issue: Freedom from Abuse and Neglect and Exploitation (2 deficiencies)

0 fire-safety deficiencies

No concentrated fire-safety issue counts in this cycle.

Fire safety

Fire-safety citations

E · Potential for more than minimal harm 2024-06-18

K345 · Smoke Deficiencies

Fire Safety

Have approved installation, maintenance and testing program for fire alarm systems.

Corrected 2024-08-16

D · Potential for more than minimal harm 2024-06-18

K100 · Construction Deficiencies

Fire Safety

Meet other general requirements.

Corrected 2024-08-16

D · Potential for more than minimal harm 2024-06-18

K291 · Egress Deficiencies

Fire Safety

Install emergency lighting that can last at least 1 1/2 hours.

Corrected 2024-08-16

D · Potential for more than minimal harm 2024-06-18

K374 · Smoke Deficiencies

Fire Safety

Install smoke barrier doors that can resist smoke for at least 20 minutes.

Corrected 2024-08-16

E · Potential for more than minimal harm 2022-10-03

K325 · Smoke Deficiencies

Fire Safety

Have properly installed hallway dispensers for alcohol-based hand rub.

Corrected 2022-11-25

E · Potential for more than minimal harm 2022-10-03

K372 · Smoke Deficiencies

Fire Safety

Ensure smoke barriers are constructed to a 1 hour fire resistance rating.

Corrected 2022-11-25

E · Potential for more than minimal harm 2022-10-03

K929 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Ensure precautions for handling oxygen cylinders and equipment are correctly followed.

Corrected 2022-11-25

D · Potential for more than minimal harm 2022-10-03

K918 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have generator or other power source capable of supplying service within 10 seconds.

Corrected 2022-11-25

Inspection history

Recent health citations

D · Potential for more than minimal harm 2025-11-05

F690 · Quality of Life and Care Deficiencies

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 2025-12-20

D · Potential for more than minimal harm 2025-05-02

F600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Corrected 2025-07-11

E · Potential for more than minimal harm 2024-06-18

F756 · Pharmacy Service Deficiencies

Health

Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

Corrected 2024-08-16

E · Potential for more than minimal harm 2024-06-18

F881 · Infection Control Deficiencies

Health

Implement a program that monitors antibiotic use.

Corrected 2024-08-16

D · Potential for more than minimal harm 2024-06-18

F578 · Resident Rights Deficiencies

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 2024-08-16

D · Potential for more than minimal harm 2024-06-18

F580 · Resident Rights Deficiencies

Health

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Corrected 2024-08-16

D · Potential for more than minimal harm 2024-06-18

F583 · Resident Rights Deficiencies

Health

Keep residents' personal and medical records private and confidential.

Corrected 2024-08-16

D · Potential for more than minimal harm 2024-06-18

F761 · Pharmacy Service Deficiencies

Health

Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Corrected 2024-08-16

D · Potential for more than minimal harm 2024-06-18

F776 · Administration Deficiencies

Health

Provide timely, approved x-ray services, or have an agreement with an approved provider to obtain them.

Corrected 2024-08-16

D · Potential for more than minimal harm 2024-02-08

F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Corrected 2024-03-22

D · Potential for more than minimal harm 2024-02-08

F610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Respond appropriately to all alleged violations.

Corrected 2024-03-22

D · Potential for more than minimal harm 2023-11-21

F658 · Resident Assessment and Care Planning Deficiencies

Health

Ensure services provided by the nursing facility meet professional standards of quality.

Corrected 2024-01-12

D · Potential for more than minimal harm 2022-10-03

F690 · Quality of Life and Care Deficiencies

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 2022-11-25

D · Potential for more than minimal harm 2022-10-03

F758 · Pharmacy Service Deficiencies

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 2022-11-25

D · Potential for more than minimal harm 2022-10-03

F804 · Nutrition and Dietary Deficiencies

Health

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Corrected 2022-11-25

D · Potential for more than minimal harm 2019-11-12

F677 · Quality of Life and Care Deficiencies

Health

Provide care and assistance to perform activities of daily living for any resident who is unable.

Corrected 2020-01-03

D · Potential for more than minimal harm 2019-11-12

F758 · Pharmacy Service Deficiencies

Health

Corrected 2020-01-03

D · Potential for more than minimal harm 2019-11-12

F804 · Nutrition and Dietary Deficiencies

Health

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Corrected 2020-01-03

D · Potential for more than minimal harm 2019-11-12

F812 · Nutrition and Dietary Deficiencies

Health

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Corrected 2020-01-03

D · Potential for more than minimal harm 2019-11-12