Rochester, NY

The Brook at High Falls Nursing Home and Rehabilit

3-star overall rating with 2-star inspections with 9 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle

2150 St. Paul Street, Rochester, NY

(585) 342-5540

Compare this facility

Overall

3 / 5

CMS overall stars

Health inspections

2 / 5

Survey and complaint cycles

Staffing

3 / 5

RN + nurse staffing

Quality measures

5 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

28

Certified beds

Average residents

24

Average occupied residents

Ownership

For-Profit

Publicly displayed owner type

Chain

No chain reported

Operator or chain grouping

Approved since

2001-01-03

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Staffing

Hours and turnover

RN hours / resident day

0.76

Registered nurse staffing

LPN hours / resident day

0.88

Licensed practical nurse staffing

Aide hours / resident day

2.45

Nurse aide staffing

Weekend hours

3.50

Weekend nurse staffing

RN turnover

71%

Annual RN turnover

Total nurse turnover

68%

Annual nurse turnover

Quality measures

Resident outcomes and process scores

Measure Facility State National Note
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine 96.1%
91.2%
4.9 pts better
93.4%
2.7 pts better
Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents experiencing one or more falls with major injury 0.0%
3.0%
3 pts better
3.3%
3.3 pts better
Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents who have depressive symptoms 0.0%
18.5%
18.5 pts better
11.4%
11.4 pts better
Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents who lose too much weight 16.7%
6.1%
10.6 pts worse
5.4%
11.3 pts worse
Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents who received an antianxiety or hypnotic medication 3.9%
13.5%
9.6 pts better
19.6%
15.7 pts better
Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents who received an antipsychotic medication 4.7%
14.8%
10.1 pts better
16.7%
12 pts better
Long Stay · 2024Q4-2025Q3
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
Percentage of long-stay residents whose need for help with daily activities has increased 21.6%
15.5%
6.1 pts worse
14.9%
6.7 pts worse
Long Stay · 2024Q4-2025Q3
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
Percentage of long-stay residents with a urinary tract infection 0.0%
1.4%
1.4 pts better
1.7%
1.7 pts better
Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents with new or worsened bowel or bladder incontinence 19.5%
20.8%
1.3 pts better
19.8%
0.3 pts better
Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents with pressure ulcers 2.0%
6.9%
4.9 pts better
5.1%
3.1 pts better
Long Stay · 2024Q4-2025Q3
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine 93.1%
76.7%
16.4 pts better
81.7%
11.4 pts better
Short Stay · 2024Q4-2025Q3
Percentage of short-stay residents who had an outpatient emergency department visit 19.7%
9.7%
10 pts worse
12.0%
7.7 pts worse
Short Stay · 20240701-20250630
Percentage of short-stay residents who newly received an antipsychotic medication 0.0%
1.2%
1.2 pts better
1.6%
1.6 pts better
Short Stay · 2024Q4-2025Q3
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine 92.8%
78.8%
14 pts better
79.7%
13.1 pts better
Short Stay · 2024Q3-2025Q2
Percentage of short-stay residents who were rehospitalized after a nursing home admission 26.8%
20.6%
6.2 pts worse
23.9%
2.9 pts worse
Short Stay · 20240701-20250630

Survey summary

Recent inspection cycles

Cycle 1 Health 2024-11-14 · Fire 2024-11-14

9 health deficiencies

Top issue: Quality of Life and Care (2 deficiencies)

3 fire-safety deficiencies

Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)

Cycle 2 Health 2023-05-10 · Fire 2023-05-10

8 health deficiencies

Top issue: Quality of Life and Care (2 deficiencies)

5 fire-safety deficiencies

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

Cycle 3 Health 2021-11-23 · Fire 2021-11-23

6 health deficiencies

Top issue: Resident Assessment and Care Planning (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 2024-11-14

K351 · Smoke Deficiencies

Fire Safety

Install an approved automatic sprinkler system.

Corrected 2025-02-05

E · Potential for more than minimal harm 2024-11-14

K761 · Miscellaneous Deficiencies

Fire Safety

To conduct inspection, testing and maintenance of fire doors by qualified individuals.

Corrected 2025-01-13

B · Minimal harm 2024-11-14

K923 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have proper medical gas storage and administration areas.

Corrected 2025-01-13

E · Potential for more than minimal harm 2023-05-10

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 2023-06-23

E · Potential for more than minimal harm 2023-05-10

K372 · Smoke Deficiencies

Fire Safety

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

Corrected 2023-06-30

E · Potential for more than minimal harm 2023-05-10

K918 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

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

Corrected 2023-06-23

C · Minimal harm 2023-05-10

E37 · Emergency Preparedness Deficiencies

Fire Safety

Establish staff and initial training requirements.

Corrected 2023-06-23

B · Minimal harm 2023-05-10

K923 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have proper medical gas storage and administration areas.

Corrected 2023-06-23

Inspection history

Recent health citations

E · Potential for more than minimal harm 2024-11-14

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 2025-01-13

E · Potential for more than minimal harm 2024-11-14

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2025-01-13

D · Potential for more than minimal harm 2024-11-14

F657 · Resident Assessment and Care Planning Deficiencies

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 2025-01-13

D · Potential for more than minimal harm 2024-11-14

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 2025-01-13

D · Potential for more than minimal harm 2024-11-14

F684 · Quality of Life and Care Deficiencies

Health

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Corrected 2025-01-13

D · Potential for more than minimal harm 2024-11-14

F803 · Nutrition and Dietary Deficiencies

Health

Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

Corrected 2025-01-13

D · Potential for more than minimal harm 2024-11-14

F914 · Environmental Deficiencies

Health

Provide bedrooms that don't allow residents to see each other when privacy is needed.

Corrected 2025-01-13

B · Minimal harm 2024-11-14

F732 · Nursing and Physician Services Deficiencies

Health

Post nurse staffing information every day.

Corrected 2025-01-13

B · Minimal harm 2024-11-14

F842 · Resident Assessment and Care Planning Deficiencies

Health

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Corrected 2025-01-13

E · Potential for more than minimal harm 2024-02-16

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 2024-05-07

E · Potential for more than minimal harm 2024-02-16

F925 · Environmental Deficiencies

Health

Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

Corrected 2024-05-07

E · Potential for more than minimal harm 2023-05-10

F727 · Nursing and Physician Services Deficiencies

Health

Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.

Corrected 2023-06-23

E · Potential for more than minimal harm 2023-05-10

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 2023-06-23

E · Potential for more than minimal harm 2023-05-10

F868 · Administration Deficiencies

Health

Have the Quality Assessment and Assurance group have the required members and meet at least quarterly

Corrected 2023-06-23

D · Potential for more than minimal harm 2023-05-10

F658 · Resident Assessment and Care Planning Deficiencies

Health

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

Corrected 2023-06-23

D · Potential for more than minimal harm 2023-05-10

F689 · Quality of Life and Care Deficiencies

Health

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Corrected 2023-06-23

D · Potential for more than minimal harm 2023-05-10

F698 · Quality of Life and Care Deficiencies

Health

Provide safe, appropriate dialysis care/services for a resident who requires such services.

Corrected 2023-06-23

D · Potential for more than minimal harm 2023-05-10

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 2023-06-23

B · Minimal harm 2023-05-10

F625 · Resident Rights Deficiencies

Health

Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.

Corrected 2023-06-23

E · Potential for more than minimal harm 2021-11-23

F636 · Resident Assessment and Care Planning Deficiencies

Health

Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.

Corrected 2022-01-14

E · Potential for more than minimal harm 2021-11-23

F638 · Resident Assessment and Care Planning Deficiencies

Health

Assure that each resident’s assessment is updated at least once every 3 months.

Corrected 2022-01-14

D · Potential for more than minimal harm 2021-11-23

F698 · Quality of Life and Care Deficiencies

Health

Provide safe, appropriate dialysis care/services for a resident who requires such services.

Corrected 2022-01-14

D · Potential for more than minimal harm 2021-11-23

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 2022-01-14

Penalties and ownership

What sits behind the stars

Ownership

Mayer, Giorgio

5% Or Greater Direct Ownership Interest · Individual

50% 12 facilities 2018-01-20
Grinspan, Aryeh

5% Or Greater Direct Ownership Interest · Individual

25% 16 facilities 2018-01-30
Mayer, Abraham

5% Or Greater Direct Ownership Interest · Individual

25% 4 facilities 2018-01-30
Grinspan, Aryeh

Corporate Officer · Individual

0% 16 facilities 2018-01-30
Mayer, Abraham

Corporate Officer · Individual

0% 4 facilities 2018-01-30
Mayer, Giorgio

Corporate Officer · Individual

0% 12 facilities 2018-01-30
Oropeza, Christina

W-2 Managing Employee · Individual

0% 1 facilities 2019-10-11

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4-star overall rating with 4-star inspections with $55,495 in total fines with 3 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle

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Health
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Staffing
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Fines
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#2

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Health
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#3

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2-star overall rating with 2-star inspections with 15 recent health deficiencies with 5 fire-safety deficiencies in the latest cycle

Overall
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Health
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Staffing
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Fines
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