South Jersey Extended Care

Based on interview and review of Nursing Staffing Report sheets, Payroll Based Journal (PBJ) Reports and facility provided documents, it was determined that the facility failed to ensure the Director of Nursing served as a charge nurse only when the facility has an average daily occupancy of 60 or fewer residents for 7 of 16 days reviewed The deficient practice was evidenced by the following: A review of the Nurse Staffing Reports completed by the facility for 05/07/2023 through 05/13/2023 revealed the facility had one RN for the day shift on 05/12/2023. On 05/12/2023, the census was 100 residents. A review of the Nurse Staffing Reports completed by the facility for 05/26/2024 through 06/01/2024 revealed the facility had one RN for the day shift on 05/26/2024 and 05/27/2024. On 05/26/2024, the census was 92 residents. On 05/27/2024, the census was was 91 residents. A review of the Nurse Staffing Reports completed by the facility for 06/02/2024 through 06/08/2024, revealed the facility had one RN for the day shift on 06/08/2024. On 06/08/2024. the census was 90 residents. On…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interview and review of facility documents, it was determined that the facility failed to provide Certified Nurse Aides (CNA) regular in-service education based on the outcome of employee job performance appraisals. The deficient practice was identified for 3 of 10 CNAs reviewed. The deficient practice was evidenced by the following: A review of the facility provided documents titled, Employee Job Performance Appraisals revealed eleven measurable attributes such as but not limited to, Job Expectations, Adaptability, Leadership, and Dependability. Each attribute also has a comments section and a goal section. Each attribute can be scored with a numeral revealing the following: 0 - Fails to Meet Expectations 1 - Needs Immediate Improvement 2 - Meets Expectations 3 - Above Average 4 - Excellent A review of CNA # 1's Employee Job Performance Appraisal revealed a score of 1 under Adaptability. Number 1 indicated, Needs Immediate Improvement. The comments and goal section were left blank. On the reverse side of the document under Leadership, the score was 1. The comments and goal…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interviews, and other facility documentation, it was determined that the facility failed to handle potentially hazardous foods and maintain sanitation in a safe consistent manner. This deficient practice was evidenced by: On 06/13/24 between 09:24 AM until 10:01 AM, the surveyor observed the following in the kitchen in the presence of the Dietary Manager (DM): 1. On 06/13/24 at 9:25 AM, the surveyor observed a Dietary Aid (DA) preparing food during the initial tour of the kitchen and was noted not wearing a beard guard. The DM stated that all staff have been trained according to the policy and procedure of the kitchen to wear proper attire while working in the kitchen. He confirmed that all staff must wear a hairnet and beard guard to prevent food contamination. The DA left the workstation and walked towards the entrance to put on his beard guard. 2. On 06/13/24 at 9:27 AM, the surveyor observed an opened package of hot dog buns containing 3 buns left in the package that was not dated with an opened date and use by date. The DM stated that items need to be…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and document review it was determined that the Licensed Nursing Home Administrator failed to ensure that facility policies and procedures were developed and consistently implemented. This failure to ensure a system was in place for residents who smoked independently and held their own smoking material and lighter, had the potential to effect all residents on 3 of 3 resident units and was evidenced by the following: On 06/13/24 at 2:03 PM, three surveyors observed a person walking behind the building on a path by the woods. The surveyors approached the person, who was by him/herself, to interview them, while the person was headed toward the road and then turned toward the parking lot. The person identified him/herself as Resident #25 and stated that he/she lived at the facility. The surveyors accompanied Resident #25 for the duration of the walk throughout the parking lot and into the main entrance and then asked the Receptionst about the resident walking around the building. The…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interview and review of pertinent facility documents it was determined that the facility failed to submit accurate No RN [Registered Nurse] Hours Payroll Based Journal (PBJ) Report to the Centers of Medicare and Medicaid Services (CMS). The deficient practice was identified for 4 of 7 infraction dates on the PBJ Report for Fiscal Year Quarter 2 January 1 - March 31. A review of the PBJ Report for Fiscal Year Quarter 2 2024 January 1 - March 31 revealed the following days as ,Infraction Date under the No RN Hours Metric: 01/27 01/28 02/24 02/25 03/10 03/23 03/24 A review of the facility provided document titled, The Following RN rotation coverage revealed that on 01/27/2024 and 01/28/2024, the facility's current Director of Nursing worked as an RN. At that time, the DON was not promoted to the DON role. A review of the same document revealed that on 03/23/2024 and 03/24/2024 the [NAME] President of Clinical Services worked as the RN. On 06/19/2024 at 1:57 PM during an interview with the surveyor, the current DON revealed she became the DON sometime in April of 2024. A review…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview and document review it was determined that the facility failed to ensure a resident room and the resident environment was free of insects, and that staff addressed a resident in a dignified manner. This deficient practice occurred for 1 of 20 residents reviewed (Resident #55) and was evidenced by the following: On 06/13/24 at 10:28 AM, Surveyor #1 observed Resident #55 in bed and there was a noticeable urine odor in the room and the resident's urinary catheter was lying on the bed. Resident #55 stated, he/she was waiting for coffee at that time and acknowledged there was an odor. Black flies were noted scattered throughout the room and when asked the resident about the flies, the resident confirmed he/she was aware of the flies. Resident #55 then stated the smell isn't from me. On 06/13/24 at 2:01 PM, Surveyor #1 and #2 observed the resident in bed on top of a pink bedspread, with the urine catheter also on the bed and the bed remote next to it. The surveyors observed two black flies on the bedspread, one on the remote and observed flying in the room.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interviews and record review, the facility failed to ensure Resident #12 preferences had been accommodated. This deficient practice occurred for 1 of 20 residents reviewed (Resident #12) for accommodation of needs and was evidenced by the following: During the initial tour on 6/14/24 at 10:31 AM, interview with Resident #12 revealed that would like to get out of the bed at a certain time and their wishes had not been honored. On 6/17/24 at 10:14 AM surveyor #2 followed up with Resident #12 regarding their concerns. The observation of Resident #12 revealed that Resident #12 was in bed dressed in a hospital gown. Resident #12 was upset and was crying to the surveyor and stated that he/she had not been able to contact their family. Resident #12 further stated that their belongings were still at the other facility and could not get in touch with the Social Worker (SW). When inquired if the resident enlisted the assistance of the SW at the current facility, Resident #12 stated, yes but nothing had been done. On 6/17/24 at 12:30 PM, the surveyor reviewed Resident #12…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and document review it was determined that the facility failed to ensure the smoking policy was followed to ensure the safety for residents who smoked and held their own cigarettes and lighters. This deficient practice occurred for 2 of 2 residents who held their own lighters (Resident #22 and #25) and was evidenced by the following: a. During the initial tour on 6/13/2024 at 09:49 AM, the surveyor observed Resident #22 in their room. Upon inquiry, Resident #22 informed the surveyor that he/she was a smoker. On 06/17/2024 at 10:38 AM, the surveyor observed Resident #22 in the designated smoking area and was smoking. On 06/18/2024 at 09:00 AM, the surveyor observed Resident #22 in their room. Resident #22 informed the surveyor that they held their own cigarettes and lighter. The resident showed to the surveyor their cigarettes and lighter and stated that the facility was aware. On 6/18/24 at 10:30 AM, the surveyor reviewed Resident #22's medical record. The admission Summary…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and review of pertinent facility documents, it was determined that the facility failed to maintain a resident bathroom toilet (Resident room [ROOM NUMBER]) in a sanitary working condition for four days and was evidenced by the following: On 06/13/2024 at 9:58 AM, during initial tour of the facility, the surveyor observed the toilet in Resident room [ROOM NUMBER]. The toilet bowl was observed with brown debris and paper products in the bowl. There was no water observed in the toilet. The resident stated that the toilet does not work, and the facility was aware the toilet had been broken for a few days. On 06/13/2024 at 12:59 PM, the surveyor reviewed the unit maintenance log sheets. The toilet in Resident room [ROOM NUMBER] was not on the log sheets to be repaired since 5/24/24. There was a work order dated 6/12/2024 for the paper towel dispenser in Resident room [ROOM NUMBER] needing batteries which was completed the same day. On 06/13/2024 at 1:12 PM, the surveyor observed the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation and interview it was determined that the facility failed to maintain all resident rooms and common areas in a clean and sanitary manner. The deficient practice occurred on 1 of 3 units and in the Sub-Acute smoking courtyard and was evidenced by the following: On 6/13/24 at 10:41 AM, two surveyors toured the Sub-Acute smoking courtyard and observed cigarette butts were located throughout the lawn area surrounding the gazebo, on top of a garbage can and partially filling the inside of an open bucket that rested on the ground which included empty cigarette packages. There were signs posted to utilize cigarette disposal not the ground. On 06/17/24 at 9:39 AM, the surveyor observed Resident #47 in bed and observed the privacy curtain was stained in several areas, there was soiled areas on several walls and a broken window blind with flies in the room. The surveyor asked about the flies and the resident confirmed there were flies in the room. On 06/19/24 at 11:13 AM, the surveyor, in the presence of the survey team informed the LNHA, Director of Nursing and Interum…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review it was determined the facility failed to conduct a new Preadmission Screening and Resident Review (PASARR) level II assessment after a resident was newly diagnosed with a mental illness. This deficient practice was identified in 1 of 2 residents reviewed for Preadmission Screening and Resident Review PASARR (Resident #44) and was evidenced by the following: Resident #44 was a resident of the facility. On 06/13/2024 at 11:43 AM the surveyor reviewed the Level I PASARR (a federal requirement to help ensure that individuals are not inappropriately placed in nursing homes for long term care) for Resident #44 dated 12/21/17 which was negative, meaning the resident did not have any mental illness diagnoses that could lead to a chronic disability. The surveyor reviewed the quarterly Minimum Data Set (MDS), an assessment tool dated 10/4/2023. The MDS reflected that Resident #44 was cognitively intact and had a diagnosis of depression. On 06/13/24 at 1:49 PM the surveyor…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, review of records, and review of pertinent documents, it was determined that the facility failed to provide appropriate incontinence care, and personal hygiene care for 1 of 2 residents. (Resident #12) reviewed for activities of daily living. The deficient practice was evidenced by the following: On 06/17/24 at 9:24 AM, the surveyor observed Resident #12 in bed. Resident #12 was alert and stated that incontinence care was not provided in a timely manner. When asked to elaborate, Resident #12 stated he/she was assisted with incontinence care at 11:00 PM and again this morning at 3:00 AM. Upon inquiry, the resident stated that he/she had not received care yet. The resident further stated that he/she was soiled and would like to be changed. The surveyor left the room and informed the Licensed Practical Nurse/Unit Manager. The Unit Manager provided the surveyor with the assignment sheet and identified the Certified Nursing Aide (CNA) assigned to the resident. On 06/17/24 at 9:44 AM, the surveyor interviewed the CNA who had Resident #12 on her assignment.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interview, record review, and pertinent facility documentation it was determined that the facility failed to identify conflicting physician's orders for emergency treatment on the medical record for 1 of 1 resident reviewed for cardio-pulmonary resuscitation (a medical procedure involving repeated compressions of a person's chest, performed in an attempt to restore blood flow to and breathing of a person whose heart stopped), resident #49. This deficient practice was evidenced by: A review of Resident #49's Order Summary Report in the Electronic Medical Record (EMR) revealed that, resident #49 had a full code order with a start date of 05/02/2024, and a DNR/DNI (do not resuscitate/do not intubate (to insert a tube into a person's throat, to help with breathing) order with a start date of 01/29/2024. A review of Resident #49's New Jersey Practitioner Orders for Life-Sustaining Treatment (POLST) dated 10/03/2022, contained the following order: Do not attempt resuscitation, allow natural death, and do not intubate. On 06/17/2024 at 12:33 PM, during an interview with the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and document review it was determined that the facility failed to ensure that a system was in place and followed to review and notify physicians of laboratory values. This deficient practice occurred for 1 of 20 residents reviewed (Resident #47) and was evidenced by the following: On 06/17/24 at 9:39 AM, observed resident in bed and respond pretty good I guess when asked how was doing. A review of the electronic medical record revealed resident was discharged to the hospital and admitted for six days, and a discharge summary from the hospital, revealed the discharge diagnoses that included acute kidney injury, altered mental status, dehydration, hypernatremia (elevated blood sodium levels), Diabetes Type 2 and Urinary Tract Infection. A Nutrition Note dated: 06/12/24, timed 17:15 [5:15 PM] that was completed by the Registered Dietitian, revealed: Assessment and Plans: Resident is on a NCS [no concentrated sweets] puree diet. Intake varies. Is supplemented with 237 ml Glucerna daily…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, record review and review of other facility documentation, it was determined that the facility failed to obtain a Physician's Order (PO) for an orthotic device for 1 of 1 resident (Resident#14) reviewed for positioning and mobility. On 06/13/2024 at 10:04 AM, the surveyor observed Resident #14 in the bed. An orthotic device was observed near Resident #14's right elbow. According to the admission Record, Resident #14 was admitted to the facility with a diagnosis including but not limited to; multiple sclerosis (a chronic disease of the central nervous system), cerebral infarction (a stroke) and hemiplegia (paralysis). Review of the Annual Minimum Data Set (MDS), an assessment tool utilized to facilitate the management of care, dated 03/30/2024, reflected that the resident was cognitively intact and had impaired use of the upper extremity on one side of the body. Review of the Order Summary Report with active orders as of 06/18/2024 did not reveal an order for Resident #14's orthotic device for the right elbow. Review of Resident #14's current Care Plan…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, record review, and review of pertinent documentation, it was determined that the facility failed to follow the physician orders related to the use of continuous oxygen (O2) for 1 of 1 resident (Resident #42) reviewed for the use of oxygen. This deficient practice was evidenced by the following: On 06/13/2024 at 9:44 AM, the surveyor observed a staff member assisting Resident #42 via a recliner chair, into the common area of the facility. The surveyor observed Resident #42 was wearing a nasal cannula attached to a portable O2 tank and the amount was set at 2 liters per minute (lpm) of oxygen. On 06/14/2024 at 8:43 AM, the surveyor observed the resident's privacy curtain drawn around the bed and could hear a staff member assisting the resident. At that time, the surveyor observed the resident's recliner chair in the hallway. The portable O2 tank was on the back of the chair and there was tubing with the nasal cannula wrapped around the tank. The nasal cannula was not in a protective covering and was exposed to the environment. On 06/14/2024 at 8:59 AM,…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, record review, and review of pertinent documentation, it was determined that the facility failed to a.) appropriately don (put on) Personal Protective Equipment (PPE), and b.) store respiratory equipment to prevent contamination and exposure to the environment. This deficient practice was evidenced by the following: On 06/13/2024 at 9:44 AM, the surveyor observed a staff member assisting Resident #42 via a recliner chair, into the common area of the facility. The surveyor observed Resident #42 was wearing a nasal cannula attached to a portable O2 tank and the amount was set at 2 liters per minute (lpm). On 06/14/2024 at 8:43 AM, the surveyor observed Resident #42's portable O2 tank was on the back of the recliner chair in the hallway. The surveyor observed that there was tubing with the nasal cannula wrapped around the tank. The nasal cannula was not in a protective covering and was exposed to the environment. On 06/14/2024 at 8:59 AM, the surveyor returned and observed Resident #42 in bed with his/her eyes closed and the oxygen tubing with the nasal…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Complaint # NJ 00167157 Based on interview and rerecords review, it was determined that the facility failed to address Resident #194's (Activities of Daily Living ) ADLs care needs by ensuring that the resident was independent with care prior to discharge. The facility did not have a care plan that addressed discharge. The facility discharged Resident #194 without addressing and acknowledging family members voiced concerns of the resident being unable to independently care for himself/herself. This deficient practice was identified for 1 of 2 residents reviewed for discharge and was evidenced by the following: On 6/17/24 at 10:30 AM, the surveyor reviewed Resident #194's closed medical record. Resident #194 was admitted to the facility on [DATE] and discharged on 6/30/23. Resident #194's diagnoses included but were not limited to; Hypertension, pulmonary emboli, deep vein thrombosis, pneumomediastenum, multiple hemorrhagic strokes and intravenous drug use. A review of the Discharge Minimum Data Set (MDS)…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Complaint # NJ 00167157 Based on interviews, record review and review of pertinent documentation provided by the facility, it was determined that the facility failed to ensure that the resident call system was maintained in operable condition as evidenced by the following: 1. On [DATE] at 11:30 AM, the surveyor entered a random resident's room and asked the resident to activate the call light in the room. The surveyor went into the hallway and observed that the light was flashing and an audible sound could be heard. During an interview with the residents, they indicated that the call light was working but staff would take time to answer the call light. One of the resident revealed that 30 minutes could elapsed before staff would answer the call light. The surveyor reviewed the Maintenance logs and observed on 2 of the 4 units the following entries: Unit CD: [DATE] outside call light broken, repaired [DATE] (room [ROOM NUMBER]) [DATE] light not working repaired [DATE]. (room [ROOM NUMBER]) [DATE] call light knob…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY COMPLAINT# NJ166159 Based on observations, interviews, medical records review, and review of other pertinent facility documentation on 8/4/2023, 8/7/2023 and 8/8/2023, it was determined that the facility failed to ensure that a resident's movement in and out of a room was not restricted. The Certified Nurse Assistant (CNA #1) tied the resident's bedroom door handle with a plastic trash bag (trash bag) and attached the other end of the trash bag to the handrail located just outside the resident's room door, which resulted in the resident not being able to exit the bedroom into the hallway. This deficient practice was identified for 1 of 5 sampled Residents (Resident #1) and was evidenced by the following: According to the face sheet, Resident #1 was admitted to the facility on [DATE], with diagnoses which included but were not limited to dementia, schizophrenia, seizure disorder, and anxiety. Review of the quarterly Minimum Data Set (MDS), an assessment tool used to facilitate the management of care, dated…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY COMPLAINT# NJ166159 Based on observations, interviews, medical records review, and review of other pertinent facility documentation on 8/4/2023, 8/7/2023 and 8/8/2023, it was determined that the facility failed to report an alleged violation and investigation to the New Jersey Department of Health (NJDOH). The alleged violation was reported to staff regarding an incident that involved a Certified Nurse Assistant (CNA #1) who tied the resident's bedroom door handle with a plastic trash bag (trash bag) and attached the other end of the trash bag to the handrail located just outside the resident's room door, thus restricting the resident's ability to exit in and out of the room. This deficient practice was identified for 1 of 5 sampled residents (Resident #1) and was evidenced by the following: According to the face sheet, Resident #1 was admitted to the facility on [DATE], with diagnoses which included but were not limited to dementia, schizophrenia, seizure disorder, and anxiety. Review of the quarterly Minimum…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and other facility documentation, it was determined that the facility failed to handle potentially hazardous foods and maintain sanitation in a safe, consistent manner. This deficient practice was evidenced by: On 03/20/23 from 9:40 AM to 10:34 AM, the surveyor observed the following in the kitchen in the presence of the Dietary Director (DD): 1. The surveyor observed the [NAME] who wore gloves as he prepared cooked pork to be served during lunch that day. The [NAME] then doffed (removed) his gloves and failed to perform hand hygiene prior to taking the surveyor on a tour of the kitchen. 2. In the walk-in refrigerator: a. On the top shelf of a four-tiered rack, there was an eight-pound container of potato salad that was marked with a use by date of 04/02/23 and failed to contain an opened date. The [NAME] stated the item was required to be discarded within three days after it was opened, and he confirmed that the opened date could not be determined. The [NAME] then proceeded to…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and review of pertinent facility documentation it was identified that the facility failed to provide residents with a clean, home like environment. This deficient practice was identified on one of three nursing units, (the AB unit) and for two (2) of 21 resident's, (Resident #45 and Resident #48) reviewed for environment and was evidenced by the following: 1.) On 03/20/23 at 10:23 AM, the surveyor observed Resident #48 laying in bed in his/her room. The surveyor further observed a Tube Feeding (TF) pole in the resident's room. The bottom of the TF pole had caked, tan material imbedded on it. The surveyor saw that the resident's beige colored privacy curtain was pushed back towards the wall by the head of the resident's bed and had a large brown, circular stain on it. At that time the surveyor attempted to interview Resident #48, but the resident was non-verbal. On 03/21/23 at 11:05 AM, the surveyor observed Resident #48 in his/her room seated in a reclining chair next to the bed. The surveyor further observed tan spillage on the bottom of the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, review of medical records and other facility documentation, it was determined that the facility failed to accurately complete the Minimum Data Set (MDS- an assessment tool utilized to facilitate the management of care) for 2 of 21 residents reviewed (Residents #45 and #65). This deficient practice was evidenced by the following: 1. On 3/20/23 at 11:03 AM, the surveyor observed Resident #45 seated in his/her room eating breakfast. According to the Medical Record, Resident #45 was admitted with a diagnosis that included schizophrenia (a mental illness.) The surveyor reviewed the Pre-admission Screening and Resident Review (PASRR) Level I and Level II for Resident # 45. It reflected that the resident had a serious mental illness. The surveyor reviewed Resident #45's Significant Change in Status MDS dated [DATE]. Section A1500 Preadmission Screening and Resident Review reflected that Resident #45 was currently NOT considered by the state level II PASRR process to have serious mental…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, review of medical records, and review of other pertinent facility documentation, it was determined that the facility failed to provide necessary services, consistent with professional standards of clinical practice by not a.) performing neurological checks (neuro-checks, an assessment of an individual's neurological functions, motor and sensory response, and level of consciousness) for a resident that fell and hit their head and b.) following facility policy and procedures. This deficient practice was identified for 1 of 4 residents (Resident # 28) reviewed for accidents and was evidenced by the following: Reference: New Jersey Statutes, Title 45, Chapter 11, Nursing Board, The Nurse Practice Act for the state of New Jersey states; The practice of nursing as a registered professional nurse is defined as diagnosing and treating human responses to actual or potential physical and emotional health problems, through such services as case finding, health teaching, health counseling,…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, review of medical records, and review of other pertinent facility documentation it was determined that the facility failed to a.) conduct a complete and thorough fall investigation and b.) update and implement fall prevention interventions on a resident's Care Plan (CP). This deficient practice was identified for 1 of 4 residents (Resident #28) reviewed for accidents and was evidenced by the following: According to Resident #28's admission Face Sheet, Resident #28 was admitted to the facility with diagnoses that included but was not limited to obstructive pulmonary disease, schizophrenia, dementia, and seizure disorder. The Annual Minimum Data Set (MDS-an assessment tool utilized to facilitate the management of care) dated 10/26/22, indicated that the resident had severe cognitive impairment and severe impairment with decision making. The MDS also reflected that the resident was independent with ambulation (walking). On 03/20/23 at 10:00 AM, during the initial tour, the surveyor…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and review of pertinent documents, it was determined that the facility failed to ensure residents received the food on the meal ticket and adhered to resident preferences. This deficient practice was identified for 1 of 1 resident (Resident # 38) reviewed for food preferences and accuracy of meal tickets and was evidenced by the following: On 3/20/23 at 10:16 AM, the surveyor observed Resident #38 lying in bed resting. According to the Medical Record, Resident #38 was admitted to the facility with diagnoses which included, but not limited to: End Stage Renal Disease (ESRD) and Hyperkalemia (high Potassium in the bloodstream). A review of the most recent Quarterly Minimum Data Set (MDS- an assessment tool used to facilitate the management of care) dated 1/10/23, revealed a Brief Interview for Mental Status score of 13 out of 15, indicating Resident #38 was cognitively intact. A review of Resident #38's care plan dated 2/13/22, revealed weight loss/gain/fluctuated related to ESRD, with interventions that included, assess dietary preferences. On 3/23/23…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.