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King Manor Care and Rehabilitation Center

2303 West Bangs Ave, Neptune, NJ 07753 · For profit - Limited Liability company · 120 certified beds · (732) 774-3500 Medicare & Medicaid certified

Call the home — (732) 774-3500 Need help choosing, fast? Free, unbiased: Eldercare Locator 1-800-677-1116
Resident-funds citations (F0568, F0569)2 actual-harm citations$108,000 in federal fines
Insights

The public record raises real questions here. Weigh the concerns below carefully.

Worth asking about
  • it has citations for mishandling residents’ money or property (F0568, F0569)
  • it has 2 actual-harm citations
  • a high number of inspection citations overall (29) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
  • the CMS record shows $108,000 in federal fines (most recent 2026-03-26)
  • its facility-reported quality-measure score sits well above its independent inspection score
  • its independent health-inspection rating is low (1/5)
  • its payroll-based staffing rating is low (2/5)

One thing this read cannot see: what residents and families actually experience day to day. Public data misses the feel of a place — visit unannounced, ideally at a mealtime or on a weekend, talk to staff and families, and ask your tour questions.

A plain-English summary of the public record below — not a rating, ranking, or recommendation. We take no money from any facility.

1/5
CMS overall
1 of 5
Health inspectionSurveyor-assigned, ranked within your stateInspector-verified 1 of 5
StaffingFrom payroll records (PBJ) 2 of 5
Quality measuresSelf-reported by the facility 4 of 5

Worth a closer look. This home's quality-measure rating runs 3 stars above its independent health-inspection score. The inspection is done by state surveyors; the quality-measure score leans on data the facility reports about itself — so a gap this large is worth reading the inspection record for.

Location & what’s nearby

Hospital
★★★★ 4/5 CMS · Emergency dept. usually open 24/7 · ER 24/7
Urgent care / clinic
444 Neptune Blvd · (732) 774-0436 · Call to confirm hours
Pharmacy
2200 NJ 66 · (732) 776-8383 · Call to confirm hours
Grocery
450 State Route 35 N · (732) 455-8055 · Call to confirm hours
Park
Monroe Ave · Typically dawn to dusk
Place of worship
1812 Monroe Ave · (732) 775-1959

Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.

Quality measures — how residents actually fare

Overall quality measures 4 of 5
Long-stay residentspeople who live here 5 of 5
Short-stay residentsrehab / post-hospital 3 of 5

Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.

Trend — is this home getting better or worse?

Over 2025-02 to 2026-06, this home’s CMS overall rating fell from 5 to 4 stars. From monthly CMS archive snapshots.

Horizontal axis runs 2025-02 to 2026-06. That is where CMS’s monthly archive ends, so the right-hand edge of each line is that month — not today.

Overall rating4★
Inspection scorelower = better
See all quality measures vs. state & national benchmarks
MeasureThis homeState avgTypical statevs typical state
Long-stay residents whose need for help with daily activities increased5.0%8.7%15.4%better
Long-stay residents who lose too much weight3.6%4.6%5.4%better
Long-stay residents with a catheter left in their bladder0.9%0.6%0.9%typical
Long-stay residents with a urinary tract infection0.0%0.8%2.0%better than state — see note marked double-dagger below the table
Long-stay residents with depressive symptoms5.9%12.1%6.5%typical
Long-stay residents who were physically restrained0.0%0.1%0.1%better
Long-stay residents with falls causing major injury0.3%2.3%3.3%better
Long-stay residents whose ability to walk worsened2.0%8.2%16.1%better
Long-stay residents on antianxiety or hypnotic medication14.9%18.8%18.9%better
Long-stay residents given the seasonal flu vaccine100.0%97.2%95.3%typical
Long-stay residents with pressure ulcers5.0%5.4%4.7%typical
Long-stay residents with worsening bladder/bowel control0.5%15.6%21.2%better
Long-stay residents who got an antipsychotic medication — see the note below the table7.1%12.7%17.1%better
Short-stay residents who newly got an antipsychotic medication0.0%1.2%1.4%better
Short-stay residents given the seasonal flu vaccine46.8%80.1%79.4%worse
Short-stay residents rehospitalized after admission30.3%24.9%22.6%worse
Short-stay residents with an outpatient ER visit11.8%8.1%12.0%typical
Long-stay hospitalizations per 1,000 resident days2.152.071.67worse
Long-stay outpatient ER visits per 1,000 resident days1.131.111.80better

‡ On this measure the state average is at least twice (or half) the typical state — a gap that size is usually how the state codes and reports the measure, not how its homes actually perform. Against a benchmark this state does not sit on, a “vs typical state” verdict would mostly be measuring the state, so we compare this home with its own state instead and show both averages.

§ Antipsychotics carry an FDA boxed warning — they raise the risk of death in older people with dementia-related psychosis, and are not approved for that use. So this measure is partly a read on whether a home sedates residents instead of staffing for them. But read a low rate carefully in both directions: CMS excludes residents coded with schizophrenia (and Tourette's or Huntington's) from this measure, and federal auditors have found implausible increases in schizophrenia coding since the measure was published — so a very low rate can reflect recoding rather than less prescribing. Ask the home what share of its residents carry a schizophrenia diagnosis, and how it handles behavioral symptoms without medication.

CMS quality measures, as Care Compare shows them. For most rows lower is better (fewer falls, ulcers, hospitalizations); vaccination rates are the exception. Not every row is risk-adjusted. CMS adjusts some measures for resident mix, but falls with major injury, antipsychotic use, physical restraints and the vaccination rates are unadjusted rates — so a home caring for heavier or more behaviorally complex residents can look worse on them without providing worse care. The “typical state” column is the median of the 50 state averages — not a national average of all homes. We use it because a plain average across homes is pulled badly off course by a few states’ reporting habits (long-stay depressive symptoms is the clearest case: Illinois codes it several times higher than most states, which alone lifted the all-homes figure to about twice what a typical state records). The median of state averages resists that — but it does weigh every state equally, so a large state counts no more than a small one, and it is a benchmark of our construction rather than a CMS-published figure. better/worse means the home differs from that benchmark by more than 10% of it; closer than that reads typical. CMS does not publish how many residents each measure covers, and the counts are often small — a single resident can move a rate by several points — so treat small gaps as noise. These come from data the facility reports, so weigh them against the independent inspection record above.

Short-stay rehab — if you are coming here from a hospital

Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.

37.5% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — which CMS reads as no different from the national rate. This is CMS’s risk-adjusted rate over 34 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

37.5%U.S. median 51.5%
Got home and stayed home
9.4%U.S. median 10.7%
Went back to hospital
95.2%U.S. median 56.6%
Met the expected recovery
0.27U.S. median 0.30
Therapy hours / resident / day
0.10hours / resident / day
Physical therapy
0.12hours / resident / day
Occupational therapy
0.05hours / resident / day
Speech therapy

Met the expected recovery: 95.2% of this home’s Medicare short-stay residents left it at or above the ability to care for themselves and move around that CMS predicted for them, across 63 stays in Oct 2024–Sep 2025. The median of the 11,061 homes CMS publishes this for is 56.6%. Read it beside the getting-home figure, not instead of it: unlike the two measures above, CMS makes no better-or-worse call on this one and publishes no confidence interval for it, so this is a comparison and not a verdict — but it is the short-stay measure that separates homes most, and the one to ask about.

Therapy staffing: this home’s payroll records show 0.27 therapist hours per resident per day in 2025Q4 — more than 41% of the 13,714 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 16% of this home’s weekday level — it runs some therapy at the weekend, at a lower level than on weekdays. The median home that reports therapy runs 14% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.

This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.

See every short-stay measure CMS publishes for this home
MeasureThis homeU.S. medianPeriod coveredCMS’s call
Got home and stayed homeRate of successful return to home or community from a SNF37.5%CMS range 25.2–53.551.5%Oct 2022–Sep 2024no different from U.S.
Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF9.4%CMS range 6.3–13.410.7%Oct 2022–Sep 2024no different from U.S.
Met the expected recoveryPercentage of residents who are at or above an expected ability to care for themselves and move around at discharge95.2%56.6%Oct 2024–Sep 2025CMS makes no comparison for this measure
Self-care at dischargePercentage of residents who are at or above an expected ability to care for themselves at discharge81.0%52.8%Oct 2024–Sep 2025CMS makes no comparison for this measure
Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge79.4%50.0%Oct 2024–Sep 2025CMS makes no comparison for this measure
Medication problems followed upPercentage of residents whose medications were reviewed and who received follow-up care when medication issues were identified100.0%98.7%Oct 2024–Sep 2025CMS makes no comparison for this measure
Medication list to the next providerPercentage of residents where the SNF provided a current medication list to the next health care setting100.0%100.0%Oct 2024–Sep 2025CMS makes no comparison for this measure
Medication list to the familyPercentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge90.6%98.7%Oct 2024–Sep 2025CMS makes no comparison for this measure
Falls with major injuryPercentage of SNF residents who experience one or more falls with major injury during their SNF stay0.0%0.0%Oct 2024–Sep 2025CMS makes no comparison for this measure
New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsened1.1%1.9%Oct 2024–Sep 2025CMS makes no comparison for this measure
Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalization7.0%CMS range 4.0–11.57.1%Oct 2023–Sep 2024no different from U.S.
Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs1.391.02Oct 2022–Sep 2024CMS makes no comparison for this measure

From the CMS Skilled Nursing Facility Quality Reporting Program — Medicare short-stay outcomes, which is a different dataset from the long-stay quality measures above and describes a different set of residents. Where CMS risk-adjusts a measure we show its adjusted rate, and the CMS range beside it is the confidence interval CMS publishes: a home whose range is wide is a home with few stays, where one patient moves the number several points. Read the period column. These measures do not share a window — the claims-based ones (getting home, readmission, spending) lag by a year or more, because a stay has to finish and its claims settle before it can be counted. CMS’s call is CMS’s, not ours: it is the only place anyone tests whether this home differs from the national rate at all, and most homes on most measures do not. Two caveats on it. CMS tests only three of these measures — getting home, readmission, and infections that led to hospital; on the other nine it publishes a rate and no comparison, and rather than compute a verdict CMS declined to make, we say so in the column. And on readmission almost every home in the country lands on “no different”, so that row separates homes far less than getting-home does — which is why met the expected recovery, a measure CMS does not test but which spreads across the whole range, is called out above the table rather than left in this list. The U.S. median column is our own, taken across every home CMS publishes that measure for in this same file; it is not a CMS-published benchmark. Homes CMS gives no rate for are left out of it rather than counted as zero. Medicare spending per stay is a ratio, not a percentage — 1.00 means this home’s Medicare spending for a stay matched the national figure CMS compares it against, and it measures cost to Medicare, not quality of care.

Staffing

0.31
RN hours/ resident / day
0.87
LPN hours/ resident / day
1.74
Aide hours/ resident / day
2.92
Total nurse hours/ resident / day
0.12
RN hoursweekends
53.8%
Total nursing turnover
75.0%
RN turnover

How full it usually is: this home is certified for 120 beds and averages 113.8 residents a day — about 95% occupied, or roughly 6 beds typically open. It runs fairly full. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.

Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 2.92 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.31 is below the 0.55-hour RN benchmark and nurse-aide staffing of 1.74 is below the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.

Weekend coverage: total nurse staffing is 2.58 hrs/resident/day on weekends vs 3.20 on weekdays — 19% thinner on weekends. RN hours go from 0.46 to 0.14 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 54% is about the same as the national median of 45%. 1 administrator has left in the past year.

Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.

Inspection trend

10 ↑
deficiencies at the latest standard inspection (2026-03-26)
6
at the previous standard inspection (2024-10-25)

Deficiencies are more than at the previous inspection — worsening. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.

Inspection deficiencies

State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.

ABCDEFGHIJKL

Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.

29 citations, most serious first. The 12 most serious are shown; the remaining 17 are one tap away and print in full.

  • Actual harm · Hcited beforedisputed · IIDR2026-03-26 · tag F0684 — failed to provide proper treatment and quality of care — pattern
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.
    What the surveyor found here — an excerpt from the official record, may be distressing

    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 staff provided care in a manner for residents to attain their highest practicable physical and psychosocial well-being by ensuring processes were put in place a.) to identify a change in condition in a timely manner, b.) to assess any decline in the functional status of a resident (Resident #58) who required assistance with bathing and was not provided a shower for over three months, and c.) to ensure a recommended physician follow-up appointment was scheduled. On 3/25/26, Resident #58 asked the surveyor to assist them in obtaining a shower, who was then showered, and the resident had a skin assessment completed by the physician who identified bilateral lower extremity cellulitis (infection) that required antibiotic treatment. This deficient practice was identified for 1 of 3 residents (Resident #58) reviewed for quality of care. The facility further failed to ensure processes were in place d.) to ensure for…

    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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Actual harm · Hdisputed · IIDR2026-03-26 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — pattern
    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and review of pertinent documents, it was determined that the facility failed to a.) provide adequate supervision and implement targeted interventions to prevent falls for a resident (Resident #58) who sustained six falls between 12/5/25 and 2/26/26, including multiple unwitnessed falls and three falls that required hospitalization. On 2/8/26, Resident #58 sustained a right periorbital hematoma (bruising and swelling of the tissue around the eye) with a 2-centimeter laceration to the right eyebrow from an unwitnessed fall. This deficient practice was identified for 1of 2 residents reviewed for falls (Resident #58). The facility further failed to b.) have a system in place to identify potential vulnerabilities of residents to reduce and mitigate potentially avoidable accidents for residents with a history of substance use disorder who signed themselves out of the facility on pass. On 8/7/26, Resident #5 signed themself out of the facility on pass at 1:30 PM, did not…

    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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · F2026-03-26 · tag F0568 — widespread
    Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview and document review it was determined that the facility failed to have a system in place to ensure quarterly financial statements were provided to residents who maintained Personal Needs Account (PNA) funds with the facility. This deficient practice was identified for 7 of 7 residents who attended a resident council meeting, and affected all 84 residents identified as maintaining a facility PNA account.The evidence was as follows: On 3/23/26 at 8:13 AM, the Licensed Nursing Home Administrator (LNHA) provided the surveyor with a list of all Personal Need Account balances as of 3/19/26. The Trial Balance listed 84 total PNA accounts with a $33,770.89 balance held by the facility. On 03/23/26 at 10:28 AM, the surveyor conducted a resident council meeting with 7 residents. When asked if the residents were provided quarterly statements for their PNA accounts, the residents stated no and they would have to request a PNA statement from the facility.On 03/24/26 at 10:39 AM, the surveyor met with Resident #56 and the regular Certified Nurse Aide (CNA) was…

    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.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Fdisputed · IDR2026-03-26 · tag F0569 — widespread
    Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation interview and document review it was determined that the facility failed to ensure a process was in place to ensure that all residents that maintained a Personal Needs Account (PNA) that approached the limit that could jeopardize a resident's eligibility for Medicaid or Supplemental Security Income (SSI) were notified. This deficient practice was identified for a resident who had PNA funds in excess of $2000.00 (Resident #56) and affected all 84 residents who maintained a facility PNA. The evidence was as follows: On 3/23/26 at 8:13 AM, the Licensed Nursing Home Administrator (LNHA) provided the surveyor with a list of all Personal Need Account balances as of 3/19/26. Resident #56 had a current balance of $2036.12, and the Trial Balance listed 84 total accounts with a $33,770.89 balance held by the facility. On 03/23/26 at 12:45 PM, the surveyor interviewed both Social Workers (SW #1 and SW #2) regarding the PNA process to assist residents to use their funds. SW #1 stated that the Activity Director talked to the residents to determine what they needed from 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.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · F2026-03-26 · tag F0725 — failed to have enough nursing staff — widespread
    Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review and review of pertinent documents it was determined that the facility failed to ensure that there was sufficient competent staff to ensure a) all residents were provided with appropriate and timely incontinence care, nail care and were consistently available to provide appropriate care to maintain residents highest practicable physical, mental, and psychosocial wellbeing and b) the minimum staffing requirements per the New Jersey Department of Health based on acuity of the residents was maintained. The deficient practice was identified for 5 of 5 residents reviewed (Resident #10, #31, # 58, #68 and #122) and had the potential to affect all residents who resided in the facility.The evidence was as follows: Refer to F677a)1. On 3/22/26 at 8:30 AM, the surveyor observed Resident #122 in bed, the resident informed the surveyor that they just finished their breakfast meal. The resident had the lid tray in their hand and informed the surveyor that they could not see, they…

    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.

    Nursing and Physician Services Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · F2026-03-26 · tag F0730 — widespread
    Observe each nurse aide's job performance and give regular training.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on interviews and review of pertinent facility documents, it was determined that the facility failed to conduct yearly performance reviews of all Certified Nursing Aides (CNA) to provide specific education aligned with the facility assessment and based on staff observed needs for improvement. This deficient practice was identified for 5 of 5 CNAs whose personnel records were reviewed, and was evidenced by the following:On 3/24/26 at 10:30 PM, the surveyor requested the Licensed Home Administrator (LNHA) to provide the list of all new hires since the last survey, including employees who were no longer employed by the facility and contracting facility's employees. On 3/24/26 at 10:00 AM, the surveyor interviewed the Nurse educator and required the orientation package, the facility assessment and the Performance Evaluation for 5 selected CNAs. The nurse educator informed the surveyor that the Director of Nursing and the LNHA were responsible for the employees' Performance evaluation. On 3/24/26 at 10:30 AM, the surveyor requested from the LNHA the performance evaluation for five…

    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.

    Nursing and Physician Services Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · F2026-03-26 · tag F0836 — widespread
    Ensure the facility is licensed under applicable State and local law and operates and provides services in compliance with all applicable Federal, State, and local laws, regulations, and codes, and with accepted professional standards.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review and review of pertinent documents it was determined that the facility failed to ensure that it maintained responsibility for the care and services provided to residents at all times, and ensure a process was in place to integrate care and services for residents who regularly attended an outside Program of All -Inclusive Care of the Elderly (PACE). This deficient practice was identified for 1 of 3 residents reviewed for accidents (Resident #115) and attended a PACE program, and had the potential to affect all residents who resided in the facility and for 6 of 6 residents who attended a PACE program.The evidence was as follows: On 3/22/26 at 8:00 AM, the survey team entered the facility to conduct a survey and at 8:10 AM, while in the lobby, the survey team observed a person ambulating with a walker, then exited the facility, placed a cigarette in their mouth, and proceeded to ambulate down a hill while smoking the cigarette. When asked, the receptionist confirmed…

    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.

    Administration Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · F2026-03-26 · tag F0847 — widespread
    Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review it was determined that the facility failed to have a process in place to ensure that prior to signing a binding arbitration agreement, that was included within the admission Packet, the agreement was clearly communicated to the resident or representative in a manner they understood, and they acknowledged they understood the agreement. The deficient practice was identified for 7 of 7 residents (Resident #15, #37, #38, #86, #102, #106, and #114) who attended a resident council meeting and a resident with a severely impaired cognition (Resident #105).The evidence was as follows: On 3/22/26 at 10:19 AM, during the facility entrance conference held with the Licensed Nursing Home Administrator (LNHA), the surveyor asked the LNHA if the facility used Arbitration Agreements and asked if any residents had signed the agreements. The LNHA stated the admission department would handle the Arbitration Agreements and that he would inform the surveyor if anyone had signed the agreement.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.

    Administration Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Fdisputed · IDR2026-03-26 · tag F0865 — failed to run a quality-improvement (QAPI) program — widespread
    Have a plan that describes the process for conducting QAPI and QAA activities.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and document review it was determined that the facility Quality Assurance and Performance Improvement (QAPI) committee failed to self-identify systems and processes that may negatively affect resident quality of care, quality of life and review significant events and implement data driven QAPI program. The deficient practice affected all residents who resided at the facility and was evidenced by the following: Refer to F568, F569, F584, F677, F679, F684, F689, F730, F925Refer to F568, F569, F584E, F677E, F679E, F684H, F689H, F730F, F925E a. On 3/23/26 at 8:13 AM, the Licensed Nursing Home Administrator (LNHA) provided the surveyor with a list of all Personal Need Account balances as of 3/19/26. Resident #56 had a current balance of $2036.12, and the Trial Balance listed 84 total accounts with a $33,770.89 balance held by the facility. On 03/24/26 at 9:47 AM, the surveyor interviewed the Business Office Manager (BOM) who worked for the management company and went to multiple…

    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.

    Administration Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Fdisputed · IDR2026-03-26 · tag F0867 — failed to act on quality-improvement findings — widespread
    Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on interview and document review, it was determined that the facility Quality Assessment and Performance Improvement (QAPI) committee failed to utilize the facility Performance Improvement Plan (PIP) to follow the facility process to measure and utilize data acquired and develop quantitative and measurable goals, this deficient practice was evidenced by the following:On 3/24/2026 at 11:00 AM, the surveyor reviewed facility provided Performance Improvement Plans (PIPs) for activities regarding resident participation, missed reimbursement related to failure to capture respiratory treatments, CNA staffing, MDS modifications, and baseline care plans. All PIPs reviewed did not include quantitative and measurable goals. In addition, there were no goals and thresholds listed for performance measurements. On 3/26/2026 at 8:42 AM, two surveyors interviewed the Licensed Nursing Home Administrator (LNHA) regarding how the facility determined what was reviewed by the QAPI team and how QAPI plans were developed. The LNHA stated every quarter the department heads would present their (PIPs)…

    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.

    Administration Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2026-03-26 · tag F0584 — failed to keep a safe, clean, comfortable home — pattern
    Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Complaint # NJ 2577317 Based on observation, interview and document review, it was determined that the facility failed to maintain the resident's living environment in a clean, comfortable and homelike manner for 4 of 4 resident rooms (#1, #13, #15 and #19) observed on 1 of 2 resident units (Rosewood), and for 1 of 2 shower rooms ([NAME]). The evidence was as follows: a. On 3/22/26 at 10:40 AM, during the initial tour, the surveyor entered Residents room [ROOM NUMBER]'s bathroom, observed broken tiles behind the toilet, four (4) of the 9 ceiling tiles had gaps which also surrounded the sprinkler head ,were deteriorated on the corners of the tiles, a plywood on top of the bathtub which was not fastened, and was covered with half a mat, positioned lengthwise. At that time, the surveyor invited the Certified Nurse Aide (CNA) to enter room [ROOM NUMBER]'s bathroom. The CNA confirmed she observed the same and stated she would inform the nurse of the concerns. On 3/22/26 at 10:45 AM, the surveyor and the CNA entered…

    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.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Ecited before2026-03-26 · tag F0677 — failed to help fully-dependent residents with daily care — pattern
    Provide care and assistance to perform activities of daily living for any resident who is unable.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and review of pertinent facility documentation, it was determined that the facility failed to ensure that residents who were dependent on staff for activities of daily living was provided with a) routine and appropriate incontinence care, b) a shower that was consistent with their needs and preferences, c) assistance to get out of bed, d) routine and appropriate nail care in a timely manner This deficient practice was identified for 4 of 4 residents reviewed for activities of daily living (Resident #10, Resident #31, Resident # 58 and Resident #122).The evidence was as follows:1) On 3/22/26 at 8:30 AM, the surveyor #1 entered Resident #122's room and observed Resident #122 in bed. Upon inquiry, Resident #122 informed the surveyor that they were not provided with incontinence care on the 11:00 PM-7:00 AM shift. The surveyor asked a Certified Nurse Aide (CNA) in the hallway to assist with an incontinence check. The CNA informed the resident of the procedure, and 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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
Show the remaining 17 citations
  • Potential for harm · E2026-03-26 · tag F0679 — failed to provide activities — pattern
    Provide activities to meet all resident's needs.
    What the surveyor found here — an excerpt from the official record, may be distressing

    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 a process was in place to provide an ongoing program to support a resident's individual activity preferences to support the psychosocial needs of the residents. The deficient practice was identified for 1 of 1 resident (Resident # 56) reviewed for activities and was evidenced by the following: On 03/24/26 at 10:39 AM, the surveyor interviewed Resident #56 and asked Resident #56 regarding what they liked to do for activities, and Resident #56's regular certified nurse aide was also present. The resident stated they loved jewelry and showed the surveyor their earrings. When asked if the resident attended the trips, the resident stated they were never asked about the trips and would go on trips. When asked if the resident walked, the resident stated they could dance and the Certified Nurse Aide (CNA) stated the resident liked to dance. On 03/24/26 at 11:00 AM, the surveyor reviewed the medical record for…

    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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Edisputed · IDR2026-03-26 · tag F0756 — failed to review each resident's drug regimen — pattern
    Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Refer to 759. Based on observation, interview, and record review, it was determined that the facility failed to ensure the recommendation made by the Consultant Pharmacist (CP) was acted upon in a timely manner for one (1) of two (2) residents (Resident #95) with a physician ordered diet of nectar thickened liquid and was evidenced by the following: On 3/23/26 at 9:45 AM, the surveyor began the Medication Observation Pass for Resident #95. The Licensed Practical Nurse (LPN) began to prepare the medication that included a physician order (PO) of Levetiracetam (Keppra) oral solution 500 milligram (mg)/5 milliliter (ml); give 10 ml by mouth every 12 hours for seizures. The order started on 12/27/25 and scheduled for administration at 9:00 AM. No additional instruction was reflected on the PO. At that time, the surveyor observed an order on the electronic Medication Administration Record (eMAR) that indicated the resident had a nectar thickened diet. On 3/23/26 at 9:52 AM, the LPN requested assistance from another…

    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.

    Pharmacy Service Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2026-03-26 · tag F0759 — failed to keep medication error rate low — pattern
    Ensure medication error rates are not 5 percent or greater.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Refer to 756. Based on observation, interview, and record review, it was determined that the facility failed to ensure that all medications were administered without error of 5% or more. During the medication administration observation on 3/23/26 and 3/24/26, the surveyor observed six (6) nurses administer medications to six (6) residents. There were 26 opportunities, and three errors were observed which resulted in a medication error rate of 7.69%. This deficient practice was identified for two (2) of six (6) residents (Resident #84 and #95), that was administered by two (2) of six (6) nurses. This deficient practice was evidenced by the following:a. On 3/23/26 at 8:46 AM, the surveyor observed the Licensed Practical Nurse (LPN #1) prepare medications for Resident #84. The medications included a physician's order (PO) of Aspercreme with Lidocaine Cream 4% (Lidocaine); apply to the right shoulder topically one time a day for chronic pain and was to be removed per schedule. The PO started on 3/13/26. At 8:52 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.

    Pharmacy Service Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Edisputed · IDR2026-03-26 · tag F0925 — failed to control pests — pattern
    Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Complaint NJ #2743500Based on observation, interview and document review, it was determined that the facility failed to maintain an effective pest control program to ensure the facility was free of cockroaches. The deficient practice had the potential to affect all residents who resided in the facility and was evidenced by the following:On 3/22/26 at 8:57 AM, Resident #54 approached surveyor and stated that they had been in the facility approximately two months and they resided in the third room since they had been admitted . The resident then proceeded to show the surveyor a plastic bag with 4 dead cockroach- like insects inside. Resident #54 then informed the surveyor the dead bugs were cockroaches. The resident then stated that when they used the bathroom during the night, and then turned on the light, they would see the cockroaches scatter. The resident also stated that they reported this to the facility, and when they sprayed for the cockroaches the last time, the Administrator was also present 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.

    Environmental Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2026-03-26 · tag F0755 — failed to provide safe pharmacy services — isolated
    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview and review of facility's documentation, the facility failed to ensure that medications were administered according to standards of practice. This deficient practice was identified for 1 of 1 resident observed with medication left unattended at the bedside (Resident #58). The evidence was as follows: On 3/22/26 at 10:00 AM the surveyor entered Resident #58's room and observed a medication cup with 6 tablets inside the cup and a cup of water on the bedside table. The surveyor observed the resident seated in the room by the bed. Upon inquiry, the resident informed the surveyor that the nurse left the medications at the bedside for them to take. The surveyor exited the room at 10:28 AM, and the medications were still at the bedside. The surveyor did not observe any other residents wandering in the hallway.On 3/22/26 at 10:30 AM, the surveyor observed the Licensed Practical Nurse (LPN) on the medication cart in the hallway and inquired regarding Resident #58's medications. The LPN stated that Resident #58 received their medications at 9:00 AM, and 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.

    Pharmacy Service Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2025-10-27 · tag F0580 — failed to tell family and doctor about changes — isolated
    Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Complaint #: 407581Based on interviews, review of medical records, and pertinent facility documents, it was determined that the facility failed to notify the resident's physician and responsible party of a change in condition for 1 of 3 residents (Resident #1) reviewed. This deficient practice was evidenced by the following:On 10/27/2025 at 8:30 AM, the surveyor reviewed the closed medical record for Resident #1.A review of the admission Record reflected that the resident was admitted to the facility with diagnoses which included but were not limited to; urinary tract infection, congestive heart failure, and chronic respiratory failure with hypoxia (inadequate supply of oxygen to the body's tissues).A review of the most recent comprehensive Minimum Data Set (MDS), an assessment tool dated 1/7/2025, reflected the resident had a Brief Interview for Mental Status (BIMS) score of 3 out of 15, which indicated a severely impaired cognition.A review of the corresponding Medication Administration Record (MAR) revealed that the resident's temperature on 2/24/2025, during an unspecified time…

    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.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2025-10-27 · tag F0684 — failed to provide proper treatment and quality of care — isolated
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Complaint #: 407581Based on interviews, record review, and review of other pertinent facility documents, it was determined that the facility failed to ensure that a resident received treatment and care in accordance with professional standards of practice, by failing to ensure that medication was administered and documented according to a physician order. This deficient practice was identified for 1 out of 3 residents reviewed for quality of care (Resident #1). This deficient practice was 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 dentist.On 10/27/2025 at 8:30 AM, 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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Ecited before2024-10-25 · tag F0677 — failed to help fully-dependent residents with daily care — pattern
    Provide care and assistance to perform activities of daily living for any resident who is unable.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Complaint # NJ 168449 Based on observation, interview, record review, and review of facility provided documents it was determined that the facility failed to consistently provide appropriate and timely incontinence care for residents who were dependent on staff for Activities of Daily Living (ADLs) care. This deficient practice was identified for 2 of 3 residents (Resident #3 and #184) reviewed for ADL care and was evidenced by the following: 1. On 10/21/24 at 8:20 AM, the surveyor conduced an initial tour of the [NAME] Unit and observed a strong urine odor in the hallway. On 10/21/24 at 8:21 AM, the surveyor observed Resident #3 in bed in their room. The surveyor inquired regarding the care received at the facility, and Resident #3 stated that they were soiled and needed to be changed. The resident, then activated the call light, and stated that staff took a long time to answer the call light. Resident #3 stated sometimes it could take one hour for staff to answer the call light and incontinence care was not…

    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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2024-10-25 · tag F0686 — failed to prevent and treat pressure sores (bedsores) — pattern
    Provide appropriate pressure ulcer care and prevent new ulcers from developing.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview, record review, and review of pertinent documentation, it was determined that the facility failed to ensure a system was in place to ensure a resident with a pressure ulcer, who was dependent on staff for care, was turned and repositioned. This deficient practice was identified for 1 of 1 resident (Resident #56) reviewed for care and services for pressure ulcers and was evidenced by the following: On 10/21/2024 at 8:32 AM, the surveyor observed Resident #56 lying in bed on their back on a scoop type mattress (a mattress with a concave center) and a Certified Nursing Aide (CNA) was assisting the resident with breakfast. CNA #1 stated that she was not too sure about the resident but knew there was a wound dressing on the resident's hip. On 10/22/2024 at 9:48 AM, the surveyor observed Resident #56 lying on their back in bed on a scoop mattress with a fall mat on one side and the bed pushed against one wall. On 10/23/2024 at 9:05 AM, the surveyor, again, observed Resident #56 lying on their back in bed on a scoop mattress. At 10:01, CNA #2 was 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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2024-10-25 · tag F0698 — failed to provide proper dialysis care — pattern
    Provide safe, appropriate dialysis care/services for a resident who requires such services.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview, record review, and review of pertinent documentation, it was determined that the facility failed to follow the Facility Assessment and facility policy to ensure that staff were educated to care for residents who required hemodialysis and had different types of access sites. The deficient practice was identified for 2 of 2 residents reviewed for dialysis (Resident #57 and #185) and was evidenced by the following: A review of the facility provided, Facility Assessment dated 2023-2024, included but was not limited to; Requirement . resident population and the resources our facility needs to care for our residents as per the recommended guidelines: The facility assessment must address or include: (1) the facility's resident population, including, but not limited to, . b. the care required by the resident population considering the types of diseases, conditions, physical, and cognitive disabilities, overall acuity, and other pertinent facts that are present with in that population; c. the staff competencies that are necessary to provide the level 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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2024-10-25 · tag F0684 — failed to provide proper treatment and quality of care — isolated
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview and record review, it was determined that the facility failed to follow a physician order for a treatment to treat a moisture associated dermatitis identified on 10/21/24. This deficient practice was identified for 1 of 21 residents reviewed (Resident #3) for quality of care and was evidenced by the following: On 10/21/24 at 8:45 AM, with the Certified Nursing Assistant (CNA) present and observed that Resident #3, a CNA #2 entered the room to provide incontinence care to Resident #3. The surveyor observed that the incontinence brief was bulging from the front to the back, and Resident #3 was wearing two incontinent briefs which were both saturated with urine and feces. The surveyor observed that the bed pad was yellow stained. CNA #2 then informed the surveyor that she had not yet provided care to the resident had visible redness on the groin and buttocks areas. The concerns were reported to the Registered Nurse (RN) Unit Manager (UM) who then generated a wound consult for Resident #3. On 10/23/24 at 11:00 AM, the surveyor reviewed the medical record…

    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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-10-25 · tag F0880 — failed to prevent and control infections — isolated
    Provide and implement an infection prevention and control program.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview, record review, and review of pertinent documentation, it was determined that the facility failed to consistently perform hand hygiene to prevent the spread of potential infection. This deficient practice was identified for 1 of 2 licensed nurses observed during the medication administration observation, and for 2 staff members observed assisting during the meal service and was evidenced by the following: 1. On 10/22/24 at 8:27 AM, Surveyor #1 observed a Licensed Practical Nurse (LPN) during the medication administration pass. The LPN was observed to enter a resident bathroom, turn on the water, applied soap to her hands, and washed her hands under the stream of water for 12 seconds. Next, the LPN dried her hands and used a paper towel to turn off the water. On 10/22/24 at 8:53 AM, the same LPN was observed in another resident bathroom. She turned on the water, applied soap, applied friction for 8 seconds outside the flow of water and next proceeded to wash her hands for 13 seconds under the flow of water. On 10/22/24 at 9:09 AM, the LPN stated that…

    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.

    Infection Control Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-10-25 · tag F0919 — failed to provide a working call system — isolated
    Make sure that a working call system is available in each resident's bathroom and bathing area.
    What the surveyor found here — the official record, unedited, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation and interview on 10/22/2024 in the presence of the Director of Maintenance (DOM) and Assistant Administrator (AA), it was determined that the facility failed to ensure that the call bell system was properly functioning in 1 of 5 tested rooms and was evidenced by the following: An observation at 1:45 PM revealed, the call bell button for room [ROOM NUMBER] window bed did not function when tested by the DOM. The facility's Assistant Administrator was informed of the deficient practice at the Life Safety Code exit conference at 1:30 PM. N.J.A.C 8:39-31:2(e)

    Environmental Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2023-06-15 · tag F0558 — failed to accommodate residents' needs and preferences — isolated
    Reasonably accommodate the needs and preferences of each resident.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview, and review of pertinent facility documents, it was determined that the facility failed to maintain a homelike environment that accommodated resident needs and preferences. This deficient practice was identified for 1 of 22 residents reviewed (Resident #59) and was evidenced by the following: On 6/6/23 at 10:46 AM, the surveyor observed Resident #59 attempting to navigate their room. Resident #59's bed was located closest to the door. Due to their height, the resident's bed was adapted with a detachable foot extension. In order to get to the opposite side of the bed, the surveyor observed Resident #59 remove the bed extension, self-propel backwards in their wheelchair past the foot of the bed, then reattach the extender. The surveyor reviewed the medical record for Resident #59. A review of the admission Record face sheet (an admission summary) reflected the resident was admitted to the facility in July of 2020, with diagnoses which included cerebral infarction (stroke) and hemiplegia (paralysis of one side of the body). A review of the most recent…

    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.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2023-06-15 · tag F0761 — failed to label and store drugs safely — isolated
    Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and review of pertinent facility documents, it was determined that the facility failed to a.) maintain medication carts free from unmarked and unwrapped medications and b.) accurately document the administration of controlled medications on the Controlled Drug Administration Record Tablet (declining inventory sheet) for an unsampled resident. This deficient practice was identified for 1 of 2 medication carts on 1 of 2 nursing units ([NAME] low- side) and was evidenced by the following: On 6/6/23 at 12:53 PM, the surveyor in the presence of the Licensed Practical Nurse (LPN) inspected the [NAME] nursing unit's low-side medication cart and observed the following: 1. Inside the top drawer on the right side of the medication cart, a small plastic medication cup which contained two unmarked tablets. At this time, the LPN identified the tablets as an iron supplement and repaglinide (diabetic medication) that she had just poured into the cup for an unsampled resident and meant 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.

    Pharmacy Service Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2023-06-15 · tag F0812 — failed to store, cook, and serve food safely — isolated
    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview, and review of facility documentation, it was determined that the facility failed to maintain kitchen equipment in a manner to prevent microbial growth. This deficient practice was evidenced by the following: On 6/6/23 at 10:01 AM, the surveyor toured the kitchen with the Food Service Director (FSD). The surveyor observed the following: In the meat kitchen hanging above the tray serving line on a utensil rack, one large and one medium rubber spatula. The spatulas were both cracked and discolored, and the medium rubber spatula was missing rubber in parts. The FSD confirmed the spatulas should not be in use. In the dairy kitchen hanging above the tray serving line on a utensil rack, one large rubber spatula cracked and discolored. The FSD confirmed the spatula should not be in use. On a rack, two large white, one medium green, one medium yellow, and one medium red cutting boards all discolored and pitted. There was also a tan rubber cutting board discolored black. The FSD stated cutting boards were changed as needed and she had not changed the cutting…

    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.

    Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2023-06-15 · tag F0921 — failed to keep a safe, functional, sanitary building — isolated
    Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and review of pertinent facility documents, it was determined that the facility failed to maintain a safe and sanitary environment for 3 of 50 residents' rooms for hand sinks (Resident room [ROOM NUMBER], #17, and #23). The deficient practice was evidenced by the following: On 6/6/23 at 9:32 AM, the surveyor observed in Resident room [ROOM NUMBER], the cabinet sink in the bathroom was in a state of disrepair. The front of the cabinet had missing laminate covering that had exposed the particle board. The doors to the cabinet were misaligned, had a missing handle, and the laminate covering was missing, which exposed the particle board on the doors. On 6/6/23 at 10:45 AM, the surveyor observed in Resident room [ROOM NUMBER], the molding in the front of the hand sink was missing and the wood was separated, exposing the particle board. The vertical molding of the sink was missing exposing the wood from the sink to the floor. On 6/623 at 11:34 AM, the surveyor observed in Resident 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.

    Environmental Deficiencies · Deficient, Provider has date of correction

“Cited before” means this same F-tag appears on at least one other survey date in the record we hold — counting complaint investigations as well as standard surveys, with no time limit. It is our own read of the data, not CMS’s: CMS uses repeat deficiency as a formal term tied to consecutive standard surveys, and that is a narrower test than this one. A tag marked here may or may not meet it.

“Disputed” is CMS’s own flag, not our reading: the CMS deficiency file records whether the home has formally contested a citation, and we reproduce that. IDR is Informal Dispute Resolution, run by the state survey agency that wrote the citation; IIDR is Independent Informal Dispute Resolution, a separate process before an outside entity, available when CMS has proposed a civil money penalty. They are different processes and we mark them differently. Two things to hold at once. A disputed citation is still a citation — it was written by a surveyor, it stands on the record unless and until it is changed, and we neither hide it nor discount it. And we cannot tell you how the dispute came out: CMS publishes that a citation is under dispute, not the outcome, so a tag marked here may since have been upheld, reduced, or deleted, and an unmarked tag may have been disputed and resolved before this file was cut. Ask the home what it disputed and why — it is entitled to tell you, and the answer is often the most informative thing on this page.

Worried about a resident here? There are three different people you can turn to, and they do different jobs:
  • Long-Term Care Ombudsman — a free, confidential advocate for the resident. They act only with the resident’s consent and work to resolve the problem. Find yours at theconsumervoice.org/get_help.
  • Adult Protective Services — the state agency that investigates suspected abuse, neglect, or exploitation of a vulnerable adult. Not sure of your state’s APS number? The federal Eldercare Locator will route you: 1-800-677-1116 or eldercare.acl.gov.
  • State survey agency — the regulator that licenses and inspects the home. Every state has an official nursing-home complaint line and most take complaints online; the Ombudsman or Eldercare Locator can connect you.
Not sure where to start, or need other help? Dial 2-1-1 for local resources — and if a call is hard or impossible for you, many local 211s also take a text (send your ZIP code to 898-211) or a web chat at 211.org; both vary by area, and 211.org will show what yours offers. Deaf or hard of hearing: dial 711 for the telecommunications relay service, then any number above. In an emergency, call 911.
It is illegal for a facility to retaliate against a resident or family for reporting a concern: federal law gives a resident the right to voice grievances — to the home or to any outside agency — without discrimination or reprisal (42 CFR §483.10(j)(1)). You may report anonymously.

Fines & penalties

$108,000 in federal fines across 1 penalty.

  • $108,000 — penalty dated 2026-03-26

Dates are the dates CMS records the penalty, not the date of the conduct behind it. CMS publishes penalties on a rolling window, so this is what is currently on the public file — not the home’s lifetime history, and an older fine may attach to a problem that has since been corrected. The amounts are as imposed: the CMS file does not record whether a penalty was appealed, reduced, or paid, so we don’t say. Ask the home what each one was for and what changed since.

Who owns this facility

Owner / managerTypeRoleShareSince
FALIK, SHIMONIndividual5% OR GREATER DIRECT OWNERSHIP INTEREST; CORPORATE OFFICER99%since 01/01/2007
MANDELBAUM, CHAIMIndividualW-2 MANAGING EMPLOYEE—since 07/01/2014

CMS files one row per role, so the 3 rows in the source record cover these 2 parties — each is shown once here with every role it holds. Nothing is omitted.

Follow the money — this home’s finances

Where a nursing home’s revenue comes from and where it goes — including money paid to companies under the same ownership. Most consumer sites never show this; we reproduce it straight from the Medicare cost report.

$10.0M
Net patient revenuemost recent cost report
-8.1%
Operating marginrevenue minus expenses
Who pays — share of resident-days
Medicaid 76%Medicare 11%Other / private 12%

About 76% of this home’s resident-days are paid by Medicaid, which reimburses well below the cost of care in most states. Heavily Medicaid-dependent homes run on thinner budgets — a context worth holding next to the staffing and inspection record, not a fault in itself. A reported operating loss is common in this industry and is not by itself a sign of trouble — but paired with large related-party payments it can mean profit is being taken elsewhere in the ownership structure.

Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2023. Facilities self-file these reports; figures are unaudited and a year or two behind. A home with no Medicare cost report on file shows no figures here.

Cost & finances

$361per resident / day
operating cost
$10,964per month
≈ monthly operating cost
$334per day
avg. revenue, all payers

Straight from this home’s Medicare cost report (CMS, FY2023). These are its operating economics — what it costs to run per resident-day and what it collects on average across Medicare, Medicaid, and private pay — not a private-pay quote. Your out-of-pocket cost depends on payer and room type, so ask the facility directly; a higher operating cost can reflect richer staffing or a sicker population. The cost-of-care planner shows regional benchmarks by care type.

What families pay in NJ

Paying with Medicaid

This is a Medicare- and Medicaid-certified nursing home, so it can accept Medicaid for long-term care — like nearly all U.S. nursing homes. The private-pay figures below are what families without Medicaid pay; once a resident qualifies for Medicaid, out-of-pocket cost for covered nursing-home care is typically close to $0 (almost all of their income goes to the home as their share of the cost; they keep a small personal needs allowance — for clothing, haircuts, a phone — and Medicaid pays the rest). The amount of that allowance is set by each state. Confirm Medicaid-bed availability with the home, and see the New Jersey Medicaid page.

Typical monthly cost in New Jersey
$12,775/mo
Nursing home (semi-private)
$14,448/mo
Nursing home (private)
$8,710/mo
Assisted living

Median private-pay cost, CareScout (Genworth) 2025 Cost of Care Survey — a regional midpoint, not any single community’s rate. Private rooms and higher care levels cost more; ask for a current quote. Project your own in the cost-of-care planner.

Every figure above is reproduced from the CMS Provider Data Catalog (a public record), from the CMS extract processed 2026-09-01 — CMS provider number 315299. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2026-03-26, which can lag current conditions. Staffing hours are CMS PBJ CY2026Q1 (Jan–Mar 2026). Check this record against the government’s own page for it: this home on Medicare Care Compare ↗ — the authoritative source, and the place to confirm anything here before you act on it. How we present it →

Not a government site. Eldercare Lens is not affiliated with, endorsed by, or authorized by the Centers for Medicare & Medicaid Services (CMS), Medicare, or any government agency. The star ratings, citations, and inspection wording on this page are reproduced from the public CMS record; the plain-English summaries, tiers, and comparisons around them are ours. We do not speak for CMS, and CMS has not reviewed this page. For the official record, go to Medicare Care Compare. How we’re funded →

Are you this operator? If the record here is out of date, or misses what you have since fixed, tell us and we will look: hello@eldercarelens.com. We reproduce the public CMS record and cannot change what it says — corrections to the underlying data go through CMS and your state survey agency — but we will correct anything we have got wrong about it, and we will say so on the page.

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