The Pines At Medford

Based on observation, interview, record review, and policy review, it was determined that the facility failed to; a) store food in a manner to prevent food-borne illness, b) maintain the kitchen environment and equipment in a sanitary manner, and c) ensure the water temperature was appropriate when utilizing the three-compartment sink to wash food preparation equipment to prevent potential for food borne illness. This deficient practice was evidenced by the following: 1. On 11/13/24 at 9:08 AM, the surveyor conducted an initial tour of the kitchen with the Food Service Director (FSD) and observed the following: - The door gasket and the door curtain on the walk-in refrigerator was torn. - The floor to the walk-in refrigerator was rusted and lifted. - The dish drying rack was rusted in appearance. On 11/13/24 at 12:04 PM, the surveyor observed the kitchen staff (KS #1) washing large pans in the three-compartment sink. The surveyor tested the wash water which felt cool, and registered 92 degrees Fahrenheit (F). The surveyor asked KS #1 if the water should be hotter, and KS #1 stated…

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 ensure garbage and recycling was managed in an appropriate manner to limit the potential for vermin and the spread of bacteria. This deficient practice had the potential to affect all residents who resided on 3 of 3 units and was evidenced by: On 11/13/24 at 9:08 AM, upon entrance to the kitchen, and in the presence of the Food Service Director (FSD), it was observed that cardboard boxes were piled up the length of a door opening by the FSD's office to the wall and were stacked in egg creates, on the floor and in a bin and the pile was at least four or more feet high. The surveyor asked the FSD why it was piled up in the kitchen and the FSD stated she did not know why because it was usually picked up 1-2 times per week. The surveyor then exited the kitchen with the FSD to view the dumpster area in the rear of the building and the following was observed: -Two garbage dumpsters did not have lids covering the garbage bags that were visible and observed various debris strewn on the ramp leading 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 interview, and review of facility documentation, it was determined that the facility failed to ensure that a facility wide assessment was reviewed and updated to identify: a) the required services and procedures necessary to protect the health, safety, and welfare of all residents; b) address staff competencies to provide resident care; c) review the facility environment to ensure safety; and d) ensure adequate facility resources to provide resident care and services. This deficient practice has the potential to affect 94 of the 94 residents at the facility during the time of survey. This deficient practice was evidenced as follows: On 11/13/24 at 10:27 AM, the survey team conducted an entrance conference with the Director of Nursing (DON). There were documents requested to complete the survey process which included but were not limited to; the Facility Assessment. The DON was unaware of a facility assessment. On 11/14/24 at 8:16 AM, the Licensed Nursing Home Administrator (LNHA) was present in the facility. The survey team made the LNHA aware of required documents…

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 documentation, it was determined that the facility failed to have in effect written transfer agreements with other Medicare and Medicaid participating facilities to ensure resident care during an emergency situation. This deficient practice had the potential to affect all residents and was evidenced by the following: On 11/13/24 at 10:27 AM, during the entrance conference with the facility administration, the facility was informed of documentation the survey team would need to review. On 11/14/24 at 12:00 PM, the surveyor asked the Licensed Nursing Home Administrator (LNHA) to view the written transfer agreement that the facility had with one or more hospitals. The LNHA was unable to provide the surveyor a written transfer agreement. On 11/15/24, the Maintenance Director (MD) provided the survey team with the facility's emergency preparedness book for review. The surveyors reviewed the book in the presence of the MD. The emergency preparedness book failed to contain any arrangements with other facilities in case of an emergency situation…

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 document review, it was determined that the facility failed to ensure that a process was in place for explaining the arbitration agreement that was included in the admission Agreement, to residents prior to having the residents sign the agreement. This deficient practice occurred for 3 of 3 residents reviewed for arbitration agreements (Resident #23, #89, and #240) and was evidenced by the following: On 11/19/24 at 10:10 AM, the Licensed Nursing Home Administrator (LNHA) provided Surveyor #9 with a list of residents who signed into a binding Arbitration Agreement (AA). The LNHA stated the admission Director (AD) was responsible for having the residents sign the agreements. On 11/19/24 at 11:00 AM, the surveyor reviewed the facility's admission Agreement. Under section J of the agreement titled Quality of Service Disputes which indicated if any dispute arises concerning the services or quality rendered to the resident, under this agreement the resident agrees to submit to binding arbitration to resolve all matters. On 11/19/24 at 11:30 AM, the surveyor reviewed…

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, interview, and record review, it was determined that the facility failed to maintain a comprehensive data driven Quality Assurance and Performance Improvement (QAPI) program with demonstrated evidence of a program to improve the quality of life of all residents. This deficient practice affected all residents who resided on 3 of 3 units (Birch, Cedar and Dogwood), and was evidenced by the following: On 11/13/24 at 10:27 AM, during the entrance conference was held with the facility administration, the surveyor requested: the QAPI plan, the QAPI program, the quality assessment and assurance (QAA) committee information, and the quarterly sign-in sheets for the QAPI meetings since the last standard survey conducted on 04/21/23. On 11/14/24 at 12:28 PM, the surveyor requested from the Licensed Nursing Home Administrator (LNHA) the QAPI plan, the QAPI program, the QAA committee information, and the quarterly sign-in sheets for the QAPI meetings since the last standard survey conducted on 04/21/23. The LNHA stated, I don't know where it is, but I will look for it. 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.

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 implement a system to identify and initiate, a comprehensive Quality Assurance Performance Improvement (QAPI) program, that developed and monitored corrective action by failing to ensure: a) hot water was available consistently for all resident care, services and facility needs; b) water temperatures did not exceed safe standards to limit the potential for 3rd degree burns; and c) a safe smoking process was in place. The deficient practice affected residents who resided on 3 of 3 units (Birch, Cedar, and Dogwood). The evidence was as follows: Refer to F600L, F689L, F835L On 11/13/24 at 10:27 AM, during the entrance conference held with the facility administration, the surveyor requested: the QAPI plan, the QAPI program, the quality assessment and assurance (QAA) committee information, and the quarterly sign-in sheets for the QAPI meetings since the last standard survey conducted on 04/21/23. Interviews 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and review of pertinent documentation, it was determined that the facility failed to ensure: a) a system was in place to monitor and minimize the risk of Legionella (a bacteria that causes the potentially fatal disease, Legionnaires') bacteria for the facility per the Center for Medicare and Medicaid Services (CMS) guidelines; b) staff performed hand hygiene (hh) in between assisting residents in the dining room; c) staff donned (put on) a Personal Protective Equipment (PPE) gown when assisting a resident on Enhanced Barrier Precautions (EBP) ( for 1 of 2 residents (Resident #83) reviewed who was on EBP); and d) the potential spread of infection was minimized by storing dirty meal trays away from other resident meal trays. This deficient practice was evidenced by the following: Reference: CMS https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO17-30-HospitalCAH-NH-REVISED-.pdf, revised 7/6/2018, included but…

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, interviews, and pertinent facility documents it was determined that the facility failed to maintain the designated emergency supply of water needed for residents in the event of a loss of normal water supply. This deficient practice was evidenced by the following: A review of the facility's Emergency Water Management and Supply policy dated last reviewed 10/2023, included: in order to maintain daily operations and resident care services, the facility has implemented an emergency water supply plan to prepare for, respond to, and recover from a total or partial interruption of the facility's normal water supply .The organization will be prepared with emergency water . one gallon per day for the total licensed beds in the facility for a total of three days . A review of the facility's Emergency Water policy dated last reviewed 10/2023, included: for drinking water, the [Food Service Director] will contact [name redacted] for emergency delivery of bottled water (see attached letter) . The facility was unable to supply the attached letter to verify this statement…

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 review of pertinent facility provided documents it was determined that the facility failed to a) ensure that within 30 days of a resident's death, the resident's funds, and a final accounting of those funds were conveyed to the resident's responsible party for 1 of 1 expired unsampled resident (UR #1) Personal Needs Account (PNA) accounts; and b) notify the resident or resident's responsible party that the funds in their PNA account reached the $2,000 maximum Supplemental Security Income (SSI) or $200 less of the maximum which could jeopardize their eligibility for SSI or Medicaid. This was identified for 5 of 56 (UR #2, UR #3, Resident # 5, Resident # 24, and Resident #53) PNA accounts reviewed and was evidenced as follows: A review of the facility's Personal Needs Accounts policy last reviewed 10/2023, included; Purpose: to provide protection and maintenance of resident funds in accordance with policies set forth by federal and state governing bodies . 6.3 . the Business Office must…

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 properly label, dispose, and store medication in 1 of 2 medication carts reviewed. The deficient practice was evidenced by the following: On 11/15/24 at 9:15 AM, the surveyor inspected the Birch Unit Medication Cart #1 in the presence of the Licensed Practical Nurse (LPN #2). The following were observed: 1. One Lantus insulin pen (prescription medication used to treat diabetes) that was opened and not dated. At that time, the LPN stated that all insulin pens should be dated with an opened date and expiration date and then discarded after 28 days. 2. One Humalog insulin pen with an expiration date of 11/02/24. A review of the Medication Administration Record (MAR) dated November 2024, revealed that the resident received the Humalog Insulin 11/15/24. 3. One bottle of Xalatan (prescription medication to treat high eye pressure) was opened and not dated. The LPN sated that the eye drop should have been dated with an opened and expiration date. On 11/20/24 at 12:51 AM, the Director 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 pertinent facility documents, it was determined that the facility failed to ensure the safe and appetizing temperatures of food and drink served to the residents. This deficient practice was identified during the lunch time meal service on 11/18/24, on 1 of 3 nursing units (Birch) food temperatures were tested in the presence of the Food Service Director (FSD) ,and was evidenced by the following: On 11/18/24 at 12:23 PM, in the presence of the FSD, the surveyor conducted a test tray with a calibrated (calibration ensures that the thermometer is accurate and precise for the measurement of food temperatures) thermometer. The meal tray cart arrived to the unit at 12:10 PM. It was an open, not an enclosed cart. The surveyor tagged the bottom tray for temperature testing. When all the meal trays were delivered to the residents from that truck at 12:15 PM, the temperatures were checked for a regular consistency meal. The temperatures were as follows: Chicken a la king: 150 degrees Fahrenheit (F) Buttered egg noodles: 118 degrees F Spinach: 140…

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#: NJ175898 Based on observation, interview and review of documentation provided by the facility, it was determined that the facility failed to maintain acceptable standards of essential kitchen equipment in a safe and operable condition. This deficient practice was evidenced by the following: During the interview with the Surveyor on 07/30/2024 at 11:33 A.M., the Food Service Director (FSD) stated that the stove in the facility's kitchen was not working. The FSD further stated the stove caught on fire in May 2024. The FSD stated that the fire department came out to extinguish the fire and deemed the stove was unsafe and needed to be repaired or replaced. The Surveyor toured the facility's kitchen with the FSD on 07/30/2024 at 11:50 A.M. and observed the following: The Surveyor observed that the stove was covered with metal sheet pans and the staff was using electric burners to cook the food. During an interview with the Surveyor on 7/30/2024 at 11:50 A.M., the FSD confirmed that the stove was not working. The FSD stated not having a stove affects the types of food that 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.

Complaint # NJ00158284, #NJ00156797 Refer to 677 Based on observation, interview, and review of pertinent facility documentation, it was determined that the facility failed to maintain the required minimum direct care staff to resident ratios as mandated by the State of New Jersey for (a) 3 of 7 day shifts, reviewed, 1 of 7 evening shifts,and 3 of 7 overnight shifts reviewed for a one week period (08/07/22 to 08/13/22), (b) 6 out of 7 day shifts reviewed during a one week period (from 09/25/2022 to 10/01/2022) (c) 14 of 14 day shifts and 2 of 14 overnight shifts during a 2 week period (03/19/2023 to 03/25/2023 and 03/26/2023 to 04/01/2023) and (d) ensure that incontinence care was provided to a dependent resident in a timely manner (Resident #77). Findings include: Reference: New Jersey Department of Health (NJDOH) memo, dated 01/28/2021, Compliance with N.J.S.A. (New Jersey Statutes Annotated) 30:13-18, new minimum staffing requirements for nursing homes, indicated the New Jersey Governor signed into law P.L. 2020 c 112, codified at N.J.S.A. 30:13-18 (the Act), which established…

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 # NJ00157501 Based on interview, record review, and review of facility documents, it was determined that the facility failed to complete neurological evaluations (neuro checks) after unwitnessed falls for 3 of 4 residents (Resident #81, #82, and #90) reviewed for falls. This deficient practice was evidenced by the following: 1. On 04/05/23 at 11:06 AM, the surveyor observed Resident #81 lying in bed watching TV. The resident stated she had fallen while at the facility, but was unsure of the details. According to the admission Record, Resident #81 had diagnoses which included, but were not limited to: muscle weakness and difficulty in walking. Review of the resident's significant change in status Minimum Data Set (MDS), an assessment tool used to facilitate the management of care, dated 02/27/23, included the resident had a Brief Interview for Mental Status score of 9, which indicated the resident's cognition was moderately impaired. Further review of the MDS revealed the resident had fallen in the last…

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 documentation, it was determined that the facility failed to evaluate the performance of all Nurse Aides (NAs) and Certified Nursing Assistants (CNAs) on an annual basis. This deficient practice occurred for 5 of 6 of the NAs and CNAs whose personnel records were reviewed (NA #1, CNAs #1, 6, 7, & 8). The deficient practice was evidenced by the following: On 04/18/23 at 9:24 AM, the surveyor reviewed the employee files of 6 NAs and CNAs, which were provided by the facility. The surveyor identified the following: NA #1 had a hire date of 01/05/21, to the housekeeping department, and a transfer date of 09/30/21, from the housekeeping department to the nursing department. According to NA #1's personnel record, the last documented competency evaluation was 03/08/21 as a housekeeper. The personnel record failed to reveal any nursing performance appraisal. CNA #1 had a hire date of 11/03/03. According to CNA #1's personnel record, the last documented performance appraisal was 11/03/20. CNA #6 had a hire date of 11/11/20. According to CNA #6's…

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 documentation, it was determined that the facility failed to handle potentially hazardous foods in a safe, consistent manner designed to prevent foodborne illness. This deficient practice was evidenced by the following: On 04/05/23 at 11:16 AM, the surveyor, in the presence of the Assistant Director of Food Service (ADFS), observed the following during the kitchen tour: 1. In the dry storage room, a employee's personal purse was stored on a shelf alongside kitchen paper products. The surveyor also observed a walker positioned against a box that was stored on a shelf. The surveyor observed the ADFS remove the purse and walker from the dry storage room. The ADFS stated the items belong to an employee and that they should not have been stored in the dry storage room. The ADFS further stated the employee's personal items should be in the office and that it was not normal practice to store personal items in the dry storage room. 2. In the dry storage room, a dented can of beets was stored on a rack alongside the undented cans. 3. In…

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 #NJ00157742, #NJ00158284 Based on observation, interview and record review, it was determined that the facility failed to maintain complete, accurate and readily accessible medical records. This deficient practice was identified for 4 of 28 residents reviewed (Resident #24, #37, #117, and #221). This deficient practice was evidenced by the following: 1. On [DATE] at 11:26 AM, during the initial tour of the Birch Unit, the surveyor observed Resident #24 awake and alert sitting in a wheelchair with the activities aide in the activity day room. The resident stated that he/she had lost weight in the past years and now weighs 205 pounds. On [DATE] at 12:38 PM, the surveyor observed Resident #24 sitting in his/her room eating his/her lunch. The resident was observed feeding himself/herself and ate about 50% of his/her meal and drank his/her milk and apple juice. Review of the hybrid paper chart and electronic medical record (EMR) revealed that Resident #24 was readmitted to the facility on [DATE] status post…

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 #NJ00156797, #NJ00159063, #NJ00158284 Refer to F836 Based on observation, interview, record review, and review of facility provided documentation, it was determined that the facility failed to a.) ensure that incontinence care was provided to a dependent resident in a timely manner and b.) maintain the required minimum direct care staff-to-resident ratios as mandated by the state of New Jersey to ensure residents received the appropriate and necessary care. This deficient practice was identified for 1 of 3 residents (Resident #77) observed for incontinence care and was evidenced by the following: On 04/13/23 at 08:25 AM, the surveyor accompanied by the Registered Nurse/Unit Manager (RN/UM #2) completed an incontinence tour on the Cedar Unit. Three random residents who were identified by RN/UM #2 as being dependent on staff for care, were checked for incontinence care. Upon walking up to Resident #77's bedroom door, a strong urine odor was noted, and the smell got stronger as you entered the room. The resident was asleep in bed with the head of bed (HOB) slightly elevated.…

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 that the facility failed to ensure that air mattresses were correctly inflated for residents with a history of wounds. This deficient practice was identified for 2 of 2 residents (Residents #45 and #73) reviewed for pressure ulcers (injuries to skin and underlying tissue resulting from prolonged pressure). The deficient practice was evidenced by the following: 1. During the initial tour on 04/05/23 at 12:00 PM, the surveyor observed Resident #45 in bed with their eyes closed. The resident did not rouse to the surveyor's greeting. The surveyor observed that the resident was on an air mattress and that the air mattress was set to 180 pounds (lbs). This would indicate that the resident weighed 180 lbs. On 04/06/23 at 9:55 AM, the surveyor observed the resident in bed. The surveyor observed that the air mattress was off. On 04/11/23 at 11:31 AM, the surveyor observed the resident in bed. The surveyor observed that the air mattress was set to 180…

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 # NJ00157742, NJ00157501, NJ00156797 Based on observation, interview, record review, and review of facility documents, it was determined that the facility failed to a.) transcribe a physician's order to monitor a resident's wander guard (a device that alarms the facility if the resident attempts to leave the building) for 1 of 3 residents (Resident #98) reviewed for elopement, and b.) ensure fall risk interventions were in place for 1 of 4 residents (Resident #90) reviewed for falls. This deficient practice was evidenced by the following: 1. On 04/05/2023 at 11:42 AM, the surveyor observed Resident #98 sitting up on the edge of the bed wearing a wander guard to his/her left wrist. According to the admission Record, Resident #98 was admitted with diagnoses which included, but were not limited to, dementia. Review of the resident's quarterly Minimum Data Set (MDS), an assessment tool used to facilitate the management of care, dated 03/21/23, included the resident had a Brief Interview for Mental Status score of 8, which indicated the resident's cognition was moderately…

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 the medical record, and review of other facility documentation, it was determined that the facility failed to ensure that an indwelling urinary catheter drainage bag (drainage bag) was stored in a way to prevent the spread of infection. This deficient practice was identified for 1 of 4 residents reviewed for the use of indwelling urinary catheters (Resident #72) and was evidenced by the following: On 04/05/23 at 11:55 AM, the surveyor observed Resident #72 resting in bed with the head of bed (HOB) slightly elevated. The resident's drainage bag was observed making contact with the floor. According to the admission Record, Resident #72 had diagnoses that included, but were not limited to: quadriplegia (a form of paralysis that affects all a person's limbs), neuromuscular dysfunction of bladder (a condition where a person lacks bladder control), and ileostomy (artificial opening in the abdominal wall). Review of the Quarterly Minimum Data Set (MDS), an assessment tool used to facilitate the management of care, dated 03/31/23, revealed 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, record review, and review of facility documents, it was determined that the facility failed to a.) properly dispose of a medication, b.) administer eye drops according to the physician's order, and c.) complete and maintain copies of Federal narcotic order forms (DEA 222 forms). This deficient practice was identified for 2 of 3 nurses observed during the medication administration pass and two DEA 222 forms reviewed and was evidenced by the following: 1. On [DATE] at 8:02 AM, the surveyor observed Licensed Practical Nurse (LPN) #1 prepare medications for Resident #37. When dispensing the medication, LPN #1 dropped a tablet of levetiracetam 250 milligrams (an anti-seizure medication) on the medication cart. The LPN then picked up the tablet from the medication cart with a gloved hand and threw it away in the trash can attached to the medication cart. During an interview with the surveyor on [DATE] at 8:55 AM, LPN #1 stated that if a medication is dropped, it should be disposed 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 record review, it was determined that the facility failed to provide a sanitary environment for residents, staff and the public by failing to a.) keep the garbage container area free of garbage and debris and b.) have a closed cover over the opening of 2 of 2 garbage containers. This deficient practice was evidenced by the following: On 04/05/23 at 11:43 AM, the surveyor toured the kitchen with the Assistant Director of Food Service (ADFS). During the tour, the ADFS led the surveyor outside to the garbage storage area. The surveyor observed two Waste Management (WM) garbage containers which did not have a cover over the top opening. The surveyor observed garbage on the ground surrounding the two containers which included used/soiled disposable single- use gloves, used surgical masks, plastic bags, plastic bottles, potato chip bags, crushed aluminum food cans, cardboard boxes, fast food Styrofoam and paper cups, milk cartons, plastic juice containers, plastic straws, soda cans, plastic cups and plastic lids to cups, disposable utensils, wet leaves,…

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 and other facility documentation, it was determined that the facility failed to maintain a medication error rate of less than 5%. This deficient practice was identified for 2 of 3 nurses administering medications to 3 of 7 residents (Resident #21, #26, and #75), making 3 errors out of 28 medication opportunities, resulting in a medication error rate of 10%. This deficient practice was evidenced by the following: On 2/23/21 at 8:15 AM, two surveyors observed a Licensed Practical Nurse (LPN #1) administer medications to Resident #26. The LPN #1 prepared three by mouth (PO) medications and Artificial Tears, an eye drop medication. After administering the PO medications to the resident, LPN #1 administered one drop of the Artificial Tears to the resident's left eye and one eye drop to the resident's right eye. LPN #1 stated to the resident, one drop in each eye. After administration, the LPN #1 signed off in the Medication Administration Record (MAR) that the eye drop medication was administered. The surveyors obtained and…

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 documentation provided by the facility, it was determined that the facility failed to maintain proper kitchen sanitation practices to limit the development of foodborne illness. This deficient practice was evidenced by the following: On 02/19/21 at 10:45 AM, during the initial tour of the kitchen and in the presence of the Food Service Director (FSD), the surveyor observed the following: 1. A Dietary Aide (DA) was in the kitchen and was wearing a hairnet. The DA's bangs were exposed and uncovered by her hairnet. The DA stated that the purpose of the hairnet was to keep hair from falling into the food. The DA stated that she did not realize her bangs were not covered and inside the hair net. The FSD noted that the DA's hair should have been completely contained in the hairnet to avoid hair falling into the food. 2. A Dietary Supervisor (DS) was observed wearing a surgical mask with his beard hair exposed outside of the surgical mask. The surgical mask was not completely covering his facial beard hair. The DS stated that he should have…

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 facility documentation review, it was determined that the facility failed to follow appropriate hand hygiene practices. This deficient practice was observed for 1 of 3 nurses who administered medications to 2 of 7 residents during the medication pass (Resident #20 and #26). This deficient practice was evidenced by the following: On 2/23/21 at 8:15 AM, two surveyors observed a Licensed Practical Nurse (LPN) administer medications to Resident #26. The LPN administered the resident's oral medications and then immediately donned gloves to administer Artificial Tears, an eye drop medication, into the resident's eyes. The LPN did not perform hand hygiene between administering the oral medications and eye drop medications. After administering the eye drops, the LPN washed her hands for 12 seconds. On 2/23/21 at 8:32 AM, two surveyors observed the same LPN administer medications to Resident #20. Afterward, the LPN washed her hands for five seconds, rinsed her hands with water, reapplied soap, and washed her hands for another five seconds. During an…

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.