01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-04-02 | 4 | 2025-04-02 | 1 |
| Cycle 2 | 2023-07-13 | 3 | 2023-07-13 | 2 |
| Cycle 3 | 2021-10-15 | 0 | 2021-10-15 | 0 |
CMS CCN 3355692026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Elderwood Of Lakeside At Brockport
170 West Avenue · Brockport, NY 14420 · Monroe County
Certified beds120CMS provider file
Recent citation rows10current CMS citation release
Penalty rows0current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
10 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 1 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-04-02 · HEALTHF0677Severity E · pattern; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Correction field: Deficient, Provider has date of correction · 2025-05-23 · complaint2025-04-02 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2025-05-232025-04-02 · HEALTHF0685Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Assist a resident in gaining access to vision and hearing services.
Correction field: Deficient, Provider has date of correction · 2025-05-232025-04-02 · HEALTHF0880Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2025-05-232025-04-02 · FIREK0353Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2025-05-302025-01-08 · HEALTHF0689Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Past Non-Compliance · 2024-05-15 · complaint2023-07-13 · HEALTHF0689Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2023-07-312023-07-13 · HEALTHF0761Severity E · pattern; potential for more than minimal harm
Pharmacy Service Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2023-07-312023-07-13 · FIREK0345Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Correction field: Deficient, Provider has date of correction · 2023-09-082023-07-13 · FIREK0918Severity D · isolated; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Correction field: Deficient, Provider has date of correction · 2023-09-0803 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| No penalty row appeared in the August 2026 penalties file. | |||
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- 170 WEST AVENUE OPERATING HOLDCO LLCOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 05/05/2016
- COLE, WARRENIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST50% · since 05/06/2016
- RUBIN, JEFFREYIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST50% · since 05/06/2016
- KLINETOB, KIMBERLYIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 11/01/2017
- COLE, WARRENIndividual · CORPORATE OFFICERNOT APPLICABLE · since 05/06/2016
- RUBIN, JEFFREYIndividual · CORPORATE OFFICERNOT APPLICABLE · since 05/06/2016
- COLE, WARRENIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/06/2016
- QUILLARD, PHILIPIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/06/2016
- RUBIN, JEFFREYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/06/2016
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours2.69per resident day
RN hours0.65per resident day
Weekend nurse hours2.17per resident day
Staff turnover68.5%CMS reported field
06 / LOCAL RECORDS
Open the New York ledger →Other published facilities nearby
No second facility in the same city met the directory rule.