Clover Rest Home

Based on observation, interview, and record review, it was determined that the facility failed to ensure that oxygen tubing was stored in accordance with infection control measures. This was found with 1 of 2 residents who received oxygen therapy, Resident #180. The deficient practice was evidenced by the following: On 5/1/25 at 11:25 AM, the surveyor observed Resident #180 in the day room participating in the activities. The surveyor observed a portable oxygen tank on the back of the wheel chair with oxygen tubing including the nasal cannula (NC) portion of tubing hanging off the tank, touching the floor and was not in use and not stored in a bag. The surveyor interviewed the Certified Nursing Assistant (CNA), who stated that the tubing should not have been on the floor. The CNA picked the tubing up off of the floor and put it into the small plastic baggie. The surveyor asked the CNA if she should have put the tubing from the floor into the bag or should have discarded it. The CNA did not respond. A review of the admission Record reflected that Resident #180 was admitted to 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 observations and interview on 01/25/2024 and 01/26/2024, it was determined that the facility failed to provide at least 80-square feet per Resident bed in multi-bedded rooms or 100-square feet in a single bedded room as evidenced by the following: On 01/25/2024 during the survey entrance at approximately 10:01 AM, a request was made to the Administrator and Director of Maintenance (DOM) to provide a copy of the facility lay-out which identifies the various rooms and smoke compartments in the facility. A review of the facility provided lay-out identified the facility is a three-story (3) building with a basement. There are eighteen (18) Resident sleeping rooms and common areas on the first floor. Starting on 01/25/2024 at approximately 10:40 AM, in the presence of the facility's DOM, the surveyor observed, measured and recorded the following Resident rooms: A-Wing Resident rooms: A-1 measured 61 square feet per resident bed A-2 measured 91.54 square feet per single bedded room A-3 measured 63.5 square feet per resident bed A-4 measured 47.5 square feet per resident bed…

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 record review it was determined that the facility failed to accurately code the Minimum Data Set (MDS), an assessment tool used to facilitate the management of care, in accordance with Federal guidelines for 1 of 15 residents, Resident #8 reviewed for accuracy for MDS coding. This deficient practice was evidenced by the following: On 1/22/24 at 11:41 AM, the surveyor observed Resident #8 sitting in a wheelchair with other residents in the day room for recreational activity. The resident was resting in the wheelchair with there eyes closed. There was no urinary catheter observed. On 1/24/24 at 9:40 AM, the surveyor reviewed the electronic and paper medical record for Resident #8. An admission Record (a summary of important information about the resident) documented the resident had diagnoses that included but were not limited to, right sided weakness following cerebral infarction (stroke), vascular dementia, anxiety disorder, urinary tract infections, hydronephrosis with renal and ureteral calculous obstruction, and overactive bladder. A review of…

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 medical records, it was determined that the facility failed to follow professional standards of practice by a.) not acquiring physician's order (PO) for the administration of Oxygen, b.) not administering the medication as ordered by the Physician and c.) by not following the facility's policy for (Peripherally Inserted Central Catheter) PICC line medication administration. This deficient practice was observed for 1 of 15 residents reviewed, Resident #19, Resident #5 and Resident #127 as evidenced by the following: Reference: New Jersey Statutes Annotated, Title 45, Chapter 11. Nursing Board. The Nurse Practice Act for the State of New Jersey states: The practice of nursing as a licensed practical nurse is defined as performing tasks and responsibilities within the framework of case finding; reinforcing the patient and family teaching program through health teaching, health counseling and provision of supportive and restorative care, under the direction of a registered nurse or licensed or otherwise legally authorized physician or…

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.

Complaint NJ #: 163054 Based on interview and review of the Nurse Staffing Report it was determined that the facility failed to ensure that a required Registered Nurse (RN) was present at the facility 7 days a week for at least 8 consecutive hours a day for 4 of 14 days reviewed. This deficient practice was evidenced by the following: Per the Interpretive Guidance §483.35(b) Facilities are responsible for ensuring they have an RN providing services at least 8 consecutive hours a day, 7 days a week. However, per Facility Assessment requirements at F838, §483.70(e), facilities are expected to identify when they may require the services of an RN for more than 8 hours a day based on the acuity level of the resident population. If it is determined the services of an RN are required for more than 8 hours a day. Facilities may choose to have differing tours of duty (e.g. 8 hour- or 12-hour shifts) for their licensed nursing staff. Regardless of the approach, the facility is responsible for ensuring the 8 hours worked by the RN are consecutive within each 24-hour period. Review of the Nurse…

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 facility policies, it was determined that the facility failed to maintain proper kitchen sanitation practices to prevent food borne illness. This deficient practice was observed and evidenced by the following: On 1/22/24 at 9:10 AM, the surveyor in the presence of the Food Service Director (FSD), observed the following during the kitchen tour: 1. In the food preparation area, the surveyor observed the microwave with a white and yellowish debris throughout the microwave. 2. Next to the refrigerator/freezer the surveyor observed an Air Condition (AC #1) unit with a heavy buildup of a brown colored dust-like debris on the air outlet grill of the AC. 3. Above the 3 compartment sink, the surveyor observed AC #2 with a heavy buildup of a brown colored dust-like debris on the air outlet grill of the AC. The FSD explained that the debris in the microwave was from the weekend staff, unable to state why nobody had cleaned the microwave. The FSD revealed that the microwave should be cleaned after each meal and/or when visibly soiled. The FSD…

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 interviews, record review, and facility policy review, it was determined that the facility failed to develop a comprehensive care plan with interventions for a diagnosis and medication management for type two diabetes mellitus for one (Resident #27) of 12 residents reviewed for care planning. This deficient practice had the potential to affect all residents. Findings included: 1. The facility admitted Resident #27 with diagnoses of type two diabetes mellitus (DM), chronic obstructive pulmonary disease, chronic respiratory failure, hyperlipidemia, and anxiety. A review of Resident #27's admission Minimum Data Set (MDS), dated [DATE], revealed a Brief Interview of Mental Status (BIMS) score of 12, which indicated moderate cognitive impairment. A further review indicated a diagnosis of DM, and Resident #27 received insulin injections during the last seven days from the time of assessment. A review of Resident #27's care plan, dated 09/22/2021, revealed no focus care area for DM, insulin use, or any other…

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 record review, staff interviews, and facility policy review, it was determined the facility failed to revise and update a care plan related to a nephrostomy tube for one (Resident #10) of 12 residents reviewed for care planning. Findings included: 1. The facility admitted Resident #10 with diagnoses that included urethral stones and obstruction, history of urosepsis, and chronic nephrostomy (an opening that is made between the kidney and the skin on your back to allow urine to drain from the kidney). A review of the quarterly Minimum Data Set (MDS) assessment, dated 08/25/2021, indicated Resident #10 was rarely/never understood. The resident had both long-term and short-term memory impairment and was severely cognitively impaired. Resident #10 had a nephrostomy tube. A review of the care plan, dated 02/24/2021, indicated Resident #10 had a nephrostomy tube inserted due to poor kidney function, urosepsis, and stones. There were goals of being and remaining free from catheter-related trauma through the next review date of 08/23/2021 and showing no signs or symptoms of urinary…

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.