Ticonderoga, NY

Elderwood At Ticonderoga

1-star overall rating with 2-star inspections with $4,516 in total fines with 10 recent health deficiencies with 4 fire-safety deficiencies in the latest cycle

101 Adirondack Drive, Ticonderoga, NY

(518) 585-6771

Compare this facility

Overall

1 / 5

CMS overall stars

Health inspections

2 / 5

Survey and complaint cycles

Staffing

1 / 5

RN + nurse staffing

Quality measures

2 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

Certified beds

Average residents

Average occupied residents

Ownership

For-Profit

Publicly displayed owner type

Chain

Elderwood

Operator or chain grouping

Approved since

1976-04-01

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

0.55

Registered nurse staffing · state 0.70 · national 0.68

LPN hours / resident day

0.56

Licensed practical nurse staffing · state 0.78 · national 0.87

Aide hours / resident day

1.77

Nurse aide staffing · state 2.20 · national 2.35

Total nurse hours

2.88

All reported nurse hours · state 3.65 · national 3.89

Licensed hours

1.11

RN + LPN hours · state 1.47 · national 1.54

Weekend hours

2.72

Weekend nurse staffing · state 3.16 · national 3.43

Weekend RN hours

0.38

Weekend registered nurse coverage · state 0.47 · national 0.47

Physical therapist

0.08

Reported PT staffing · state 0.11 · national 0.07

Adjusted RN hours

0.57

CMS adjusted RN staffing hours

Adjusted total hours

2.99

CMS adjusted total nurse staffing hours

Case-mix index

1.32

Higher values indicate more complex resident acuity

RN turnover

50%

Annual RN turnover · state 41% · national 45%

Total nurse turnover

49%

Annual nurse turnover · state 41% · national 46%

SNF VBP

Value-based purchasing

Program rank

5,420

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

Performance score

36.25

Composite VBP score used to determine payment impact.

Payment multiplier

0.9897

Above 1.000 increases Medicare payment; below 1.000 reduces it.

Program components

How the VBP score is built

Readmission

6.63

Baseline 18.81% · Performance 18.36% · Measure score 6.63 · Achievement 6.63 · Improvement 2.02

Healthcare-associated infections

2.25

Baseline 7.08% · Performance 7.16% · Measure score 2.25 · Achievement 2.25 · Improvement 0

Total nurse turnover

5.42

Baseline 44.29% · Performance 41.54% · Measure score 5.42 · Achievement 5.42 · Improvement 0.91

Adjusted total nurse staffing

0.20

Baseline 3.01 hours · Performance 3.20 hours · Measure score 0.20 · Achievement 0 · Improvement 0.20

SNF QRP

Medicare quality reporting measures

Measure	Facility	National	Note
Potentially preventable 30-day readmission	12.94%	10.72% 2.2 pts worse	No Different than the National Rate · Eligible stays 83 · Observed rate 15.66% · Lower 95% interval 8.83%
Discharge to community	32.87%	50.57% 17.7 pts worse	Worse than the National Rate · Eligible stays 77 · Observed rate 25.97% · Lower 95% interval 26.82%
Medicare spending per beneficiary	1.04	1.02 About the same
Drug regimen review with follow-up	93.88%	95.27% 1.4 pts worse	Numerator 46 · Denominator 49
Falls with major injury	2.04%	0.77% 1.3 pts worse	Numerator 1 · Denominator 49
Discharge self-care score	41.86%	53.69% 11.8 pts worse	Numerator 18 · Denominator 43
Discharge mobility score	41.86%	50.94% 9.1 pts worse	Numerator 18 · Denominator 43
Pressure ulcers or injuries, new or worsened	0%	2.29% 2.3 pts better	Numerator 0 · Denominator 49 · Adjusted rate 0%
Healthcare-associated infections requiring hospitalization	7.16%	7.12% About the same	No Different than the National Rate · Eligible stays 53 · Observed rate 5.66% · Lower 95% interval 4.2%
Staff COVID-19 vaccination coverage	5.34%	8.2% 2.9 pts worse	Numerator 7 · Denominator 131
Staff flu vaccination coverage	68.89%	42% 26.9 pts better	Numerator 93 · Denominator 135
Discharge function score	46.51%	56.45% 9.9 pts worse	Numerator 20 · Denominator 43
Transfer of health information to provider	Not Available	95.95%	Numerator Not Available · Denominator 5 · Too few residents or stays to report publicly.
Transfer of health information to patient	Not Available	96.28%	Numerator Not Available · Denominator 17 · Too few residents or stays to report publicly.
Resident COVID-19 vaccinations up to date	55.17%	25.2% 30 pts better	Numerator 16 · Denominator 29

Quality measures

Resident outcomes and process scores

Measure	Facility	State	National	Note
Number of hospitalizations per 1000 long-stay resident days	1.1	1.7 0.6 pts better	1.9 0.8 pts better	Long Stay · 20240701-20250630 · Adjusted 1.1 · Observed 1.1 · Expected 1.9 · Used in QM five-star
Number of outpatient emergency department visits per 1000 long-stay resident days	4.2	1.3 2.9 pts worse	1.8 2.4 pts worse	Long Stay · 20240701-20250630 · Adjusted 4.2 · Observed 4.3 · Expected 1.7 · Used in QM five-star
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine	90.4%	91.2% 0.8 pts worse	93.4% 3 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 91.3% · Q2 91.0% · Q3 90.2% · Q4 88.9% · 4Q avg 90.4%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine	94.4%	95.3% 0.9 pts worse	95.5% 1.1 pts worse	Long Stay · 2024Q3-2025Q2 · 4Q avg 94.4%
Percentage of long-stay residents experiencing one or more falls with major injury	4.6%	3.0% 1.6 pts worse	3.3% 1.3 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 4.3% · Q2 6.0% · Q3 3.3% · Q4 4.8% · 4Q avg 4.6% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms	10.0%	18.5% 8.5 pts better	11.4% 1.4 pts better	Long Stay · 2024Q4-2025Q3 · Q1 8.8% · Q2 16.4% · Q3 8.2% · Q4 6.7% · 4Q avg 10.0%
Percentage of long-stay residents who lose too much weight	4.8%	6.1% 1.3 pts better	5.4% 0.6 pts better	Long Stay · 2024Q4-2025Q3 · Q1 1.5% · Q2 9.7% · Q3 5.0% · Q4 3.3% · 4Q avg 4.8%
Percentage of long-stay residents who received an antianxiety or hypnotic medication	29.6%	13.5% 16.1 pts worse	19.6% 10 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 23.2% · Q2 32.8% · Q3 34.4% · Q4 28.6% · 4Q avg 29.6%
Percentage of long-stay residents who received an antipsychotic medication	13.6%	14.8% 1.2 pts better	16.7% 3.1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 9.4% · Q2 17.4% · Q3 13.5% · Q4 14.5% · 4Q avg 13.6% · 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	22.5%	15.1% 7.4 pts worse	16.3% 6.2 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 29.7% · Q2 22.2% · Q3 17.6% · Q4 20.9% · 4Q avg 22.5% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased	25.4%	15.5% 9.9 pts worse	14.9% 10.5 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 26.6% · Q2 30.5% · Q3 22.8% · Q4 21.7% · 4Q avg 25.4% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder	0.0%	0.6% 0.6 pts better	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% · Used in QM five-star
Percentage of long-stay residents with a urinary tract infection	2.4%	1.4% 1 pts worse	1.7% 0.7 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 3.1% · Q2 4.6% · Q3 1.7% · Q4 0.0% · 4Q avg 2.4% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence	34.1%	20.8% 13.3 pts worse	19.8% 14.3 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 47.6% · Q2 25.2% · Q3 33.8% · Q4 29.2% · 4Q avg 34.1%
Percentage of long-stay residents with pressure ulcers	8.9%	6.9% 2 pts worse	5.1% 3.8 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 7.0% · Q2 12.5% · Q3 8.1% · Q4 8.0% · 4Q avg 8.9% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine	64.2%	76.7% 12.5 pts worse	81.7% 17.5 pts worse	Short Stay · 2024Q4-2025Q3 · Q1 61.1% · Q2 63.3% · Q3 61.0% · Q4 69.1% · 4Q avg 64.2%
Percentage of short-stay residents who had an outpatient emergency department visit	31.4%	9.7% 21.7 pts worse	12.0% 19.4 pts worse	Short Stay · 20240701-20250630 · Adjusted 31.4% · Observed 28.9% · Expected 10.3% · Used in QM five-star
Percentage of short-stay residents who newly received an antipsychotic medication	4.5%	1.2% 3.3 pts worse	1.6% 2.9 pts worse	Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 8.7% · Q3 6.2% · Q4 3.0% · 4Q avg 4.5% · Used in QM five-star
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine	57.4%	78.8% 21.4 pts worse	79.7% 22.3 pts worse	Short Stay · 2024Q3-2025Q2 · 4Q avg 57.4%
Percentage of short-stay residents who were rehospitalized after a nursing home admission	14.9%	20.6% 5.7 pts better	23.9% 9 pts better	Short Stay · 20240701-20250630 · Adjusted 14.9% · Observed 13.3% · Expected 21.4% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2024-07-15 · Fire 2024-07-15

10 health deficiencies

Top issue: Quality of Life and Care (3 deficiencies)

4 fire-safety deficiencies

Top issue: Emergency Preparedness (2 deficiencies)

Cycle 2 Health 2021-09-23 · Fire 2021-09-23

6 health deficiencies

Top issue: Nutrition and Dietary (2 deficiencies)

3 fire-safety deficiencies

Top issue: Smoke (2 deficiencies)

Cycle 3 Health 2019-04-26 · Fire 2019-04-26

11 health deficiencies

Top issue: Pharmacy Service (3 deficiencies)

4 fire-safety deficiencies

Top issue: Smoke (2 deficiencies)

Fire safety

Fire-safety citations

F · Potential for more than minimal harm 2024-07-15

E26 · Emergency Preparedness Deficiencies

Fire Safety

Establish roles under a Waiver declared by secretary.

Corrected 2024-05-09

F · Potential for more than minimal harm 2024-07-15

E7 · Emergency Preparedness Deficiencies

Fire Safety

Address patient/client population and determine types of services needed.

Corrected 2024-05-09

E · Potential for more than minimal harm 2024-07-15

K211 · Egress Deficiencies

Fire Safety

Keep aisles, corridors, and exits free of obstruction in case of emergency.

Corrected 2024-03-26

E · Potential for more than minimal harm 2024-07-15

K341 · Smoke Deficiencies

Fire Safety

Install a fire alarm system that can be heard throughout the facility.

Corrected 2024-05-08

F · Potential for more than minimal harm 2021-09-23

K222 · Egress Deficiencies

Fire Safety

Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.

Corrected 2021-11-01

E · Potential for more than minimal harm 2021-09-23

K311 · Smoke Deficiencies

Fire Safety

Have an enclosure around a vertical opening shaft.

Corrected 2021-11-19

E · Potential for more than minimal harm 2021-09-23

K372 · Smoke Deficiencies

Fire Safety

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

Corrected 2021-10-31

E · Potential for more than minimal harm 2019-04-26

K271 · Egress Deficiencies

Fire Safety

Have exits that are accessible at all times.

Corrected 2019-06-24

E · Potential for more than minimal harm 2019-04-26

K311 · Smoke Deficiencies

Fire Safety

Have an enclosure around a vertical opening shaft.

Corrected 2019-06-24

E · Potential for more than minimal harm 2019-04-26

K372 · Smoke Deficiencies

Fire Safety

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

Corrected 2019-06-24

E · Potential for more than minimal harm 2019-04-26

K926 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk.

Corrected 2019-06-24

Inspection history

Recent health citations

D · Potential for more than minimal harm 2025-08-20

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 2025-09-08

D · Potential for more than minimal harm 2025-08-20

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 2025-09-08

F · Potential for more than minimal harm 2024-07-15

F692 · Quality of Life and Care Deficiencies

Health

Provide enough food/fluids to maintain a resident's health.

Corrected 2024-09-06

F · Potential for more than minimal harm 2024-07-15

F805 · Nutrition and Dietary Deficiencies

Health

Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.

Corrected 2024-09-10

E · Potential for more than minimal harm 2024-07-15

F804 · Nutrition and Dietary Deficiencies

Health

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

Corrected 2024-09-10

D · Potential for more than minimal harm 2024-07-15

F604 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.

Corrected 2024-09-10

D · Potential for more than minimal harm 2024-07-15

F610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Respond appropriately to all alleged violations.

Corrected 2024-08-14

D · Potential for more than minimal harm 2024-07-15

F656 · Resident Assessment and Care Planning Deficiencies

Health

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Corrected 2024-09-06

D · Potential for more than minimal harm 2024-07-15

F679 · Quality of Life and Care Deficiencies

Health

Provide activities to meet all resident's needs.

Corrected 2024-09-06

D · Potential for more than minimal harm 2024-07-15

F755 · Pharmacy Service Deficiencies

Health

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Corrected 2024-09-10

D · Potential for more than minimal harm 2024-07-15

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 2024-09-10

E · Potential for more than minimal harm 2021-09-23

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 2021-10-20

D · Potential for more than minimal harm 2021-09-23

F761 · Pharmacy Service Deficiencies

Health

Corrected 2021-10-22

D · Potential for more than minimal harm 2021-09-23

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2021-10-22

C · Minimal harm 2021-09-23

F584 · Resident Rights Deficiencies

Health

Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

Corrected 2021-10-22

C · Minimal harm 2021-09-23

F814 · Nutrition and Dietary Deficiencies

Health

Dispose of garbage and refuse properly.

Corrected 2021-10-20

E · Potential for more than minimal harm 2019-04-26

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 2019-06-25

E · Potential for more than minimal harm 2019-04-26

F836 · Administration Deficiencies

Health

Ensure the facility is licensed under applicable State and local law and operates and provides services in compliance with all applicable Federal, State, and local laws, regulations, and codes, and with accepted professional standards.

Corrected 2019-05-24

E · Potential for more than minimal harm 2019-04-26