Llanfair House Care & Rehabilitation Center

Location & what’s nearby

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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

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.

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.

45.5% 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 35 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

Met the expected recovery: 56.7% 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 30 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 0.18 therapist hours per resident per day in 2026Q1 — more than 18% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 22% 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 13% — 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.

Staffing

How full it usually is: this home is certified for 180 beds and averages 104.3 residents a day — about 58% occupied, or roughly 76 beds typically open. It often has substantial empty capacity — worth asking why, since low census can reflect either a new or shrinking home or one families are avoiding. 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 3.46 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.63 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 2.11 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 2.95 hrs/resident/day on weekends vs 3.67 on weekdays — 19% thinner on weekends. RN hours go from 0.71 to 0.44 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 50% is about the same as the national median of 45%.

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

Deficiencies are fewer than at the previous inspection — improving. 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.

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.

36 citations, most serious first. The 15 most serious are shown; the remaining 21 are one tap away and print in full.

• Immediate jeopardy · L2022-11-03 · tag F0835 — failed to run the facility competently — widespread
  Administer the facility in a manner that enables it to use its resources effectively and efficiently.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Complaint NJ00157677 Refer F689, and F836 Based on observations, interviews, review of medical records, and review of facility documents, it was determined that the facility's Licensed Nursing Home Administrator (LNHA) failed to ensure that the policies and procedures were implemented to ensure resident safety and well-being to prevent serious harm, by failing to: a.) identify sufficient staffing numbers to address the population census and needs of their residents, and b.) ensure they were also meeting New Jersey state minimum staffing requirements for 32 of 42 total shifts over a two week period of time from 9/25/22 through 10/08/22, yet the LNHA continued to allow the admission of seven (7) new residents during this two week period prior to survey. The LNHA's failure to identify their sufficient staffing benchmark and include it in the Facility Assessment and the failure to ensure the New Jersey state minimum staffing requirements were being met by a wide margin, all while continuing to admit new residents to the facility places all residents at risk for serious harm, impairment,…

  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
• Immediate jeopardy · L2022-11-03 · 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

  Complaint #NJ00157677 Reference F677 and F689 Based on observation, interview, and review of pertinent facility documents, it was determined that the facility failed to: a.) ensure the facility was meeting New Jersey state minimum staffing requirements, and b.) identify their own sufficient staffing numbers necessary to meet their census population and resident needs. The survey team reviewed the staffing levels for the two weeks prior to the survey (9/25/22 to 10/8/22). It was determined that the facility was significantly deficient in Certified Nursing Aide (CNA) staffing for 14 of 14 day shifts in which most days, the facility was only meeting half of the required CNA's for the day shift (CNA's had between 13 to 26 residents each on their assignment when the NJ state requirement is 1 CNA to 8 Residents for the day shift). The Facility was also deficient in staffing the evening (3-11 PM) shift for 4 of 14 evening shifts, and 14 of 14 night (11 PM- 7 AM) shifts. Upon a review of the Facility Assessment (FA), it was determined that the facility did not identify or assess their…

  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
• Immediate jeopardy · Kcited before2022-11-03 · 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 PART A Based on observation, interview, record review and review of other pertinent facility documentation, it was determined that the facility failed to ensure that Resident #47 who was at risk for falls and with a diagnosis of Dementia was supervised, assessed, evaluated, and monitored to determine the cause of each fall and to prevent future falls, including a fall that resulted in serious injury. This deficient practice was identified for 1 of the 3 residents reviewed for falls. Resident #47 sustained 11 falls from 5/26/22 through 10/10/22 over a six month period of time. Seven (7) of the 11 of the falls were unwitnessed falls with most of the falls reoccurring in common areas (hallways and dining room). A review of the Investigation reports for the 11 falls revealed that they were incomplete and did not conclude possible causes/root cause of the falls. Further the investigations did not evaluate what interventions were in place at the time of the falls, nor did it address interventions or appropriate…

  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
• Immediate jeopardy · J2022-11-03 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation, interview, record review, and review of other pertinent facility documentation, it was determined the facility failed to ensure that Resident #2 was free from physical abuse from a staff Licensed Practical Nurse. On 7/30/22 during the evening shift, Resident #2 was a victim of physical abuse by a Licensed Practical Nurse #1 (LPN#1) when LPN #1 punched Resident #2 on the left side of the face with a closed fist causing the resident to fall to the ground. This incident was witnessed by two facility staff, a Certified Nursing Aide (CNA #1) and a second Licensed Practical Nurse (LPN #2). The resident exhibited pain after the incident. LPN#1's failure to prevent physical abuse by punching Resident #2 with a closed fist causing the resident to fall posed a likelihood of serious harm, impairment or death to that resident on 7/30/22, resulting in an immediate jeopardy (IJ) situation that began on 7/30/22. The facility immediately suspended and terminated LPN #1 and notified all necessary parties and governing agencies and implemented additional measures to protect…

  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.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Past Non-Compliance
• Actual harm · G2024-12-16 · tag F0686 — failed to prevent and treat pressure sores (bedsores) — isolated
  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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Complaint #'s: NJ175457, NJ175482 Based on observation, interview, and record review, it was determined that the facility failed to report a newly developed pressure ulcer (PU) and implement a physician's order (PO) for wound care to treat a facility acquired PU for 1 of 3 residents reviewed for PU's, (Resident #110). The PU worsened from an excoriation (wearing off the skin) that was identified on 6/20/24 to an unstageable PU ( covered with slough (a soft, yellow or white, often stringy material that accumulates on the surface of a wound) or eschar (a layer of dry, dead tissue that forms over a deep wound) and cannot be staged which are caused by prolonged pressure, shear and friction and can lead to infection and complications). This deficient practice was evidenced by the following: On 12/5/24 at 10:30 AM, the surveyor reviewed the hybrid medical records (paper and electronic) of Resident #110, which revealed the following: A review of the admission Record (an admission summary) reflected that Resident #110…

  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 · Fcited before2024-12-16 · tag F0658 — failed to meet professional standards of care — widespread
  Ensure services provided by the nursing facility meet professional standards of quality.
  What the surveyor found here — an excerpt from the official record, may be distressing

  REPEAT DEFICIENCY Based on observation, interview, and record review, it was determined that the facility failed to: a.) follow a physician's order (PO) for a bolus feeding (method of giving tube feeding where large doses of formula are administered several times a day) in one (1) of two (2) residents (Resident #51) reviewed for tube feeding (TF) and b.) failed to document for accountability of medications and treatments administered for 4 of 5 residents (Resident #28, #83, #88 and #110) reviewed for unnecessary medication. This deficient practice was evidenced by the following: Reference: New Jersey Statues, Annotated Title 45, Chapter 11 Nursing Board, The Nurse Practice Act for the State of New Jersey states; The practice of nursing as a registered professional nurse is defined as diagnosing and treating human responses to actual or potential physical and emotional health problems, through such services as case finding, health teaching, health counseling, and provision of care supportive to or restorative of life and wellbeing, and executing a medical regimens as prescribed by a…

  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 Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Fcited before2024-12-16 · tag F0711 — widespread
  Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit.
  What the surveyor found here — an excerpt from the official record, may be distressing

  REPEAT DEFICIENCY Based on observation, interview, and record review, it was determined that the facility failed to ensure the resident's primary physician (MD #1, MD #4) accurately dated their physician progress notes (PPN) during their visit to ensure the resident's current medical regimen was up to date. This deficient practice was observed for 8 of 16 residents, (Resident #41, # 51, #110, #45, #66, #84, and #71). This deficient practice was evidenced by the following: 1. On 12/4/24 at 11:07 AM, the surveyor interviewed Resident #41 in their room. The resident further stated to the surveyor they could not recall the last time they were assessed by their physician. A review of Resident #41's Face Sheet (an admission summary) reflected that Resident #41 was admitted to the facility with diagnoses that included but not limited to Schizophrenia, Chronic Kidney disease, and End Stage Renal Disease. A review of the 5-Day Minimum Data Set (MDS), an assessment tool used to facilitate care management dated 11/23/2024, indicated a Brief Interview for Mental Status (BIMS) scored of 14 out…

  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 · E2024-12-16 · tag F0582 — pattern
  Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
  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 issue the required Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN) for 3 of 3 residents (Resident #30, Resident #83, and Resident #13) reviewed. This deficient practice was evidenced by: The SNF ABN provides information to beneficiaries so that they can decide if they wish to continue receiving the skilled services that may not be paid for by Medicare and assume financial responsibility. If the SNF provides the beneficiary with the SNF ABN, the facility has met its obligation to inform the beneficiary of his or her potential financial liability and related standard claim appeal rights. On 12/9/24 at 9:45 AM, the facility provided the surveyor with a list of residents who were discharged from the facility within the last 6 months and should have received the SNF ABN form. The surveyor reviewed Resident #30, Resident #83 and Resident #27 who were listed discharged from Medicare Part A coverage stay 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.

  Resident Rights Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2024-12-16 · tag F0657 — failed to keep the care plan current — isolated
  Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
  What the surveyor found here — an excerpt from the official record, may be distressing

  REPEAT DEFICIENCY Complaints # NJ175457, NJ175482 Based on observations, interviews, and record review, it was determined that the facility failed to revise the comprehensive care plans (CP) for 2 of 28 residents reviewed (Resident #51 and #110). This deficient practice was identified by the following: 1. On 12/4/24 at 11:10 AM, during initial tour, the surveyor observed the Resident #51 in bed with their eyes closed. The surveyor reviewed Resident #51's hybrid (paper and electronic) medical records. A review of the admission Record (an admission summary) (AR) for Resident #51 reflected that the resident was admitted to the facility with diagnoses which included but not limited to Anemia (a condition in which blood doesn't have enough healthy red blood cells and hemoglobin, a protein found in red blood cells, to carry oxygen all through the body), type 2 Diabetes Mellitus (a long-term condition in which the body has trouble controlling blood sugar and using it for energy), nontraumatic subdural hemorrhage (a rare condition that occurs without a head trauma) and gastrostomy (presence…

  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 Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2024-12-16 · tag F0695 — failed to provide proper breathing / tracheostomy care — isolated
  Provide safe and appropriate respiratory care for a resident when needed.
  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 maintain respiratory equipment in a sanitary manner for a resident who was receiving continuous oxygen (O2). The deficient practice was identified for 1 of 1 resident (Resident #95) reviewed for respiratory care. The deficient practice was evidenced by the following: On 12/4/24 at 11:46 AM, the surveyor observed Resident # 95 in bed with eyes closed with O2 in use via nasal cannula (a medical device used for delivering O2) at 4 Liters Per Minute (LPM.). The surveyor further observed the O2 tubing was dated 11/5/24. A review of the Face Sheet (an admission record) revealed that the resident was admitted to the facility with diagnosis that included but not were not limited to Pneumonia, Chronic Respiratory Failure, and Pulmonary Fibrosis. A review of the quarterly Minimum Data Set Assessment (Q/MDS), an assessment tool, used to facilitate the management of care, dated 9/2/24, reflected that the resident had a Brief Interview for Mental Status score of 14 out of 15 indicating that the…

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

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2024-12-16 · tag F0712 — isolated
  Ensure that the resident and his/her doctor meet face-to-face at all required visits.
  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 the physician responsible for supervising the care of residents conducted face to face visits and wrote progress notes at least once every 30 days for Medicaid recipient residents and once every 60 days for Medicare recipient residents. This deficient practice was identified for 2 of 22 residents (Resident #95 and Resident 103), reviewed for physician visits and was evidenced by the following: 1. On 12/04/24 at 11:46 AM, the surveyor observed Resident # 95 with eyes closed. The surveyor reviewed the hybrid medical records (paper and electronic) (HMR) for the Resident #95 which revealed that the resident's primary physician (PP) (MD#2) no Physician Progress Notes (PPN) since Resident #95 was admitted to the facility on [DATE]. The surveyor reviewed Resident 95's Face Sheet (an admission record) which revealed that the resident was admitted to the facility with diagnosis that included but not limited 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.

  Nursing and Physician Services Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2024-12-16 · tag F0756 — failed to review each resident's drug regimen — isolated
  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

  Based on observation, interview, and record review, it was determined that the facility failed to respond to the Consultant Pharmacist's (CP) monthly recommendations in a timely manner for 1 of 22 residents (Resident #51) reviewed. The deficient practice was evidenced by the following: On 12/04/24 at 11:10 AM, during initial tour, the surveyor observed the Resident #51 in bed with their eyes closed. The surveyor reviewed Resident #51's hybrid medical records. A review of the admission Record (an admission summary) (AR) for Resident #51 reflected that the resident was admitted to the facility with diagnoses which included but not limited to Anemia (a condition in which blood doesn't have enough healthy red blood cells and hemoglobin, a protein found in red blood cells, to carry oxygen all through the body), type 2 diabetes mellitus (a long-term condition in which the body has trouble controlling blood sugar and using it for energy), nontraumatic subdural hemorrhage (a rare condition that occurs without a head trauma) and gastrostomy (presence of a surgical opening into the stomach,…

  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 · D2024-12-16 · 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

  Based on observation, interview, and record review, it was determined that the facility failed to properly label, dispose and secure medications in one (1) of five (5) medication carts and one (1) of five (5) treatment carts inspected. This deficient practice was evidenced by the following: On 12/9/24 at 9:15 AM, the surveyor during observation of medication administration observed the 1st floor long-side treatment cart that was unlocked and unattended. The treatment cart contained ointments and creams. The surveyor did observe any residents near the treatment cart. At that time, the surveyor interviewed the Licensed Practical Nurse (LPN#1) who acknowledged that the treatment cart was unlocked and further stated that the treatment cart must always be locked when unattended. On 12/12/24 at 11:35 AM, the surveyor inspected the 1st floor short-side medication cart in the presence of LPN#2. The surveyor observed an opened bottle of blood glucose test strips that was not dated. The surveyor also observed an unopened and undated Humalog insulin pen. At that time, the surveyor interviewed…

  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 · D2024-12-16 · tag F0842 — failed to keep accurate, complete medical records — isolated
  Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance 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, and record review, it was determined that the facility failed to maintain complete, accurate, readily accessible medical records, and legible physician's progress notes (PPN). This deficient practice was identified for 2 of 22 residents reviewed, Resident #5 and #51, and was evidenced by the following: This deficient practice was evidenced by the following: 1. On 12/4/24 at 11:10 AM, during initial tour, the surveyor observed the Resident #51 in bed with their eyes closed. The surveyor reviewed Resident #51's hybrid (paper and electronic) medical records (HMR). A review of the admission Record (an admission summary) (AR) for Resident #51 reflected that the resident was admitted to the facility with diagnoses which included but not limited to Anemia (a condition in which blood doesn't have enough healthy red blood cells and hemoglobin, a protein found in red blood cells, to carry oxygen all through the body), type 2 Diabetes Mellitus (a long-term condition in which the body has…

  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 Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Ecited before2023-11-09 · 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

  Based on observation, interview, and record review, it was determined that the facility failed to ensure required monthly visits by the Consultant Pharmacist (CP) for the months of August, September, and October 2023. This irregularity was identified for 17 of 17 residents reviewed by the survey team for CP review, Resident #78, #8, #89, #71, #85, #40, #86, #90, #52, #91, #68, #75, #24, #46, #63, #59, #22, #70, #88 and #36. The deficient practice was evidenced by the following: On 10/30/23 at 12:30 PM, after completing the facility unit inspection, the surveyor asked the Director of Nursing (DON) for the Consultant Pharmacist (CP) 2023 previous unit inspections. The DON informed the surveyor that the facility had unit inspections performed by the CP until July 2023. The DON also informed the surveyor that the facility did not have a CP perform monthly medication reviews as they received notification in July 2023 that the CP company would no longer service the facility. On 11/2/23 at 10:00 AM, the DON informed the surveyor that the previous Consulting Pharmacist company could no…

  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

“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.

Fines & penalties

$47,304 in federal fines across 1 penalty.

• $47,304 — penalty dated 2024-12-16

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.

Part of a chain

This home belongs to MB HEALTHCARE — 12 facilities. Here is how its ratings compare with the chain’s average across all its homes: See the whole chain — ratings, flags, fines and finances →

A home rated well below its chain’s average can signal local problems; a chain with a low average across the board is a bigger pattern worth researching. CMS chain data under-reports private-equity and REIT ownership, so treat this as a floor, not the full picture.

Who owns this facility

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.

About 89% 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. This home reported $1.5M paid to related parties — landlords or management companies under common ownership — equal to about 11% of its total expenses. Money routed to affiliated companies can leave a home’s own books looking lean while owners still profit; it is the mechanism regulators watch most closely in private-equity and REIT deals. 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

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