Aristacare At Norwood Terrace

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, it was determined that the facility failed to develop and implement a care plan that meets the medical needs identified on the comprehensive assessment care for 1 of 20 residents reviewed for comprehensive care plans. (Resident #94). This deficient practice was evidenced by the following: A review of Resident # 94's admissions record revealed that, Resident # 94 was admitted with but not limited to Heart Failure, Asthma (a long-term inflammatory disease in the lungs), and Acute Pulmonary Edema (a buildup of fluid in the lungs), A review of Resident #94's admission Minimum Data Set (MDS) dated [DATE] revealed under section O that the resident received continues oxygen. A review of Resident #94's Electronical Medical Record revealed a physician's order with a state date of 02/03/2025 for oxygen at 2 liters via nasal cannula (a tube that delivers oxygen into the nose) every shift for shortness of breath. A review of the current Care Plan (CP) for Resident #94 did not include…

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.

Compliant #NJ00175438 Based on observation, interview, and pertinent facility documentation, it was determined that the facility failed to ensure that incontinence care was provided to a dependent resident in a timely manner. This deficient practice was identified for 1 of 20 residents (Resident #73) during incontinence care observations on 1 of the 2 units (2nd and 3rd Floors). This deficient practice was evidenced by the following: On 03/27/2025 at 10:14 AM, during the initial tour of the facility, the surveyors noted a strong odor of fecal matter and urine in the hallway on the third floor, immediately upon exiting the elevators. On 03/27/2025 at 10:15 AM, the surveyor observed Resident #73 sitting on the bed in his/her bedroom with his/her pants down, exposing a brown stained and torn incontinent brief. There was also brown debris on the front of the resident's pants, and the room had a strong ammonia-like odor. During an incontinence tour on the 3rd floor with the surveyor on 03/27/2025 at 10:18 AM, the Registered Nurse/Unit Manager (RN/UM) said that Resident #73's incontinent…

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

Based on observation, interview, record review, and pertinent facility documents it was determined that the facility failed to provide appropriate and sufficient treatment and care based upon current standards of practice specifically by allowing a catheter drainage bag to be in contact with the floor. The deficient practice was identified for 1 of 1 resident (Resident # 7) reviewed for Urinary Catheter or Urinary Tract Infection. On 3/27/2025 at 10:59 AM during the initial tour, the surveyor observed Resident # 7 in bed. At that time, the surveyor observed a catheter drainage bag covered by a privacy bag secured to the bed frame but in contact with the floor below. On 3/28/2025 at 10:50 AM, the surveyor observed Resident # 7 in bed. At that time, the surveyor observed a catheter drainage bag covered by a privacy bag secured to the bed frame but in contact with the floor below. The tube connected to the drain bag was also in contact with the floor. On 4/2/2025 at 10:22 AM, the surveyor observed Resident # 7 sitting on the side of the bed. At that time, the surveyor observed the…

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

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, review of medical records, and review of other facility documentation, it was determined that the facility failed to implement infection control measures for the handling and storage of respiratory equipment for 1 of 2 residents reviewed for respiratory care (Residents #94). This deficient practice was evidenced by the following: On 03/28/2025 at 11:41 AM, during rounds the surveyor observed Resident #94 sitting in bed in his/her room with the nasal cannula (a tube used to deliver oxygen through the nose) rolled up exposed to the air on top of the oxygen concentrator (a medical device that delivers extra oxygen to the patient). The oxygen concentrator was turned on. On 04/01/2025 at 10:46 AM during rounds the surveyor observed Resident # 94's nasal cannula rolled up and exposed to air on the top of the oxygen concentrator. Resident #94 was out of the facility at this time. A review of Resident # 94's admissions record revealed that, Resident # 94 was admitted with but not limited…

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 review of facility documentation, it was determined that the facility failed to a.) properly handle and store potentially hazardous foods in a manner that is intended to prevent the spread of food borne illnesses and b.) maintain equipment and kitchen areas in a manner to prevent microbial growth and cross contamination. This deficient practice was evidenced by the following: On 01/23/2023 at 9:54 AM, the surveyor toured the kitchen, in the presence of the Director of Dietary (DOD) and observed the following: In the food preparation area, there were 4 cartons of milk and 6 dessert cups that were sitting on the table, unlabeled, and not refrigerated or being kept cold on ice. The DOD stated the items were left over from breakfast and confirmed the milk and dessert cups should have been labeled and refrigerated. In the main area of the kitchen against the wall next to the refrigerator, there were several boxes of ice cream that were unlabeled in the stand alone ice cream freezer…

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 review of facility documentation, it was determined that the facility failed to accurately assess two residents' status in the Minimum Data Set (MDS), an assessment tool used to evaluate resident's care needs. This deficient practice was observed for 2 of 22 residents reviewed, Resident #21 and #31 and was evidenced by the following: 1. Review of the admission Record indicated that Resident #31 was admitted to the facility on 4/2013. Review of the most recent quarterly MDS dated [DATE] indicated that Resident #31 had a Brief Interview of Mental Status of 3, meaning the resident had severe cognitive impairment. Medical Diagnosis for Resident #31 included, but not limited to dementia, urinary calculus (kidney stones), dysphasia (difficulty swallowing), hypothyroidism (slow thyroid function), and hypertension (high blood pressure). On 01/27/2023 at 09:45 AM, the surveyor reviewed the most recent quarterly MDS dated [DATE]. Under section H, titled bowel and bladder no was marked…

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 the facility failed to maintain profession standards of clinical practice for 2 of 22 residents (Resident #8 and #66) reviewed by a.) documenting on the Treatment Administration Record (TAR) that preventative heel boots were applied to a resident when they were not and not following the physicians most recent order for heel boots and b.) correctly transcribe an order to the Medication Administration Record (MAR) to remove a medication patch. This deficient practice was evidenced by the following: a.) On 01/23/23 at 10:53 AM, during the initial tour of the facility Resident #8 was observed in bed. The surveyor observed that there were foot boots on the resident's nightstand. Resident #8 told the surveyor they get put on at night. The surveyor asked the resident if he/she could move legs and the resident said, not at all. Review of the admission Record indicated that Resident #8 was admitted to the facility on 11/2016. Review of the most recent annual Minimum Data Set (MDS), an assessment tool dated 11/15/22 showed…

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 obtain physician orders for urinary catheter care for Resident #31, 1 of 2 resident reviewed for urinary catheters and was evidenced by the following: On 01/23/23 at 10:40 AM, during the initial tour of the facility Resident #31 was in the bed. The surveyor observed a urinary catheter tubing with dark yellow urine hanging at the bedside. The urinary collection bag was in a privacy bag. Review of the admission Record indicated that Resident #31 was admitted to the facility on 4/2013. Review of the most recent quarterly Minimum Data Set (MDS), an assessment tool dated 12/26/22 indicated that Resident #31 had a Brief Interview of Mental Status of 3, meaning the resident had severe cognitive impairment. Review of section G, functional status, of the MDS indicated the resident was a two-person assist for transfers, mobility, dressing, and personal hygiene. Medical Diagnosis for Resident #31 included, but not limited to dementia, urinary calculus (kidney stones), dysphasia…

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 other facility documentation, it was determined that the facility failed to obtain a physician order for the use of oxygen for 1 of 1 residents reviewed for oxygen, (Resident #19). This deficient practice was evidenced by the following: During the initial tour of the facility on 01/23/23 at 10:40 AM the surveyor observed Resident # 19 in bed receiving Oxygen via nasal cannula (a device used to deliver supplemental oxygen). On 01/24/23 at 11:48 AM and on 01/26/23 10:41 AM the surveyor observed Resident #19 receiving Oxygen via nasal cannula. According to the admission Record, Resident #19 was admitted to the facility with diagnosis of Chronic Obstructive Pulmonary Disease (COPD). The surveyor reviewed the Clinical Physician Orders for Resident #19 and did not observe an order for Oxygen. The surveyor reviewed the January 2023 Medication Administration Record (MAR) and Treatment Administration Record (TAR) and did not observe an order for Oxygen. During an interview on 01/26/23 at 11:12 AM, the assigned Licensed…

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: a.) remove controlled drugs (Valium, Ativan bottle #1 and Ativan bottle #2) from active inventory stored in the refrigerator in a timely manner when the controlled drugs were discontinued on 5/1/2020, 12/31/20 and 2/18/21 respectively, b.) perform accountability and reconciliation for controlled drugs (Valium and Ativan bottle #1) and c.) remove a controlled drug (Ativan bottle #2) that had expired on 1/18/21. This deficient practice was identified for 1 of 2 refrigerated medication storage units reviewed and was evidenced by the following: On 3/31/21 at 11:02 AM, two surveyors reviewed the medications stored in the refrigerator on the nursing unit with the Licensed Practical Nurse (LPN) At that time, the surveyors observed in the refrigerated locked box three (3) controlled drugs: 1.) An antianxiety/sedative medication, Diazepam (Valium) 10 milligram (mg) suppositories with a count of 15 labeled for Resident #44. 2.) An unopened bottle of an antianxiety medication Ativan. It was a 30…

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 all medications were administered without an error rate of 5% or more. During the medication pass on 3/31/21, the surveyor observed two (2) nurses administer medications to six (6) residents. There were 34 opportunities and two (2) errors observed which calculated to a medication administration error rate of 5.8%. This deficient practice was identified for 2 of 2 nurses administering medication to 2 of 6 residents, (Resident #25 and #73). The evidence was as follows: 1. On 3/31/21 at 8:43 AM, the surveyor conducted the medication pass in the presence of a second surveyor. At that time, the surveyor observed the Licensed Practical Nurse (LPN #1), during the medication pass, preparing to administer five (5) medications including one tablet of Sucralfate (Carafate) one (1) gram (GM) (a medication used to treat the lining of the stomach). The surveyor with LPN #1 observed Resident #25 sitting in a chair…

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 facility documentation, it was determined that the facility failed to ensure: a.) a long-acting scheduled dose of an antipsychotic medication (Haldol) was administered every 28 days in accordance with a resident's psychiatric plan of care, and b.) a comprehensive care plan was in place to address the resident's antipsychotic medication (Haldol). This deficient practice was identified for 1 of 5 residents reviewed for unnecessary medications (Resident #227). The evidence was as follows: On 3/31/21 at 8:25 AM, the surveyor observed Resident #227 seated on the edge of the bed in his/her room. The resident appeared comfortable and was well-groomed. The surveyor observed that the resident was wearing a Darco boot (a post-surgical walking boot) on the right foot and holding a black pouch with a Wound-VAC (vacuum assisted closure) device (a medical device that provides negative pressure to a wound bed to promote healing and reduce drainage). 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.