Deficiencies per Year
4
3
2
1
0
Unclassified
Census Over Time
Census
Capacity
Notice
Deficiencies: 0
Nov 20, 2025
Visit Reason
This document serves to inform individuals about the privacy practices of NJDHSS, including how their medical information may be used and disclosed, and their rights related to this information.
Findings
The notice explains the types of information covered, reasons for use and disclosure of health information, individuals' rights to access and control their information, and the legal duties of NJDHSS to protect privacy.
Report Facts
Effective date: 2011
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Devon L. Graf | Director, Office of Legal and Regulatory Compliance | Listed as NJDHSS Privacy Officer contact for questions about the notice |
Inspection Report
Complaint Investigation
Census: 56
Deficiencies: 2
Nov 29, 2024
Visit Reason
The inspection was conducted as a complaint investigation based on Complaint # NJ 0180281 to determine compliance with New Jersey Administrative Code standards for assisted living residences.
Findings
The facility was found not in substantial compliance with standards, specifically failing to ensure a safe environment for residents, including leaving toasters on kitchen countertops when not in use, and failing to update and revise the service plan for Resident #1. Immediate corrective actions were required.
Complaint Details
Complaint # NJ 0180281 was substantiated as the facility failed to ensure a safe environment and proper care for Resident #1 and others, as evidenced by observations, interviews, and record reviews.
Deficiencies (2)
| Description |
|---|
| Failure to ensure a safe environment by leaving toasters on countertops when not in use, endangering residents' safety. |
| Failure to revise and update the Service Plan with interventions to address Resident #1's needs. |
Report Facts
Sample Size: 3
Date of Survey Completion: Nov 29, 2024
Inspection Report
Complaint Investigation
Census: 33
Deficiencies: 3
Jun 21, 2023
Visit Reason
The inspection was conducted as a complaint investigation based on complaints NJ00164971 and NJ00164748 regarding compliance with New Jersey Administrative Code standards for licensure of assisted living residences.
Findings
The facility was found not in substantial compliance with standards, specifically failing to retain a completed Universal Transfer Form for one resident, failing to provide an incident report for a resident's fall, and lacking documented evidence of half-hour safety checks as required by the resident's service plan.
Complaint Details
Complaint investigation for NJ00164971 and NJ00164748. The complaint was substantiated based on failure to retain transfer documentation, failure to provide incident reports, and failure to document safety checks for Resident #2.
Deficiencies (3)
| Description |
|---|
| Failure to retain a completed Universal Transfer Form (UTF) for Resident #2 when transferred to hospital. |
| Failure to provide an incident report, incident summary, or investigation report for Resident #2's fall incident. |
| Failure to provide documented evidence that half-hour safety checks were implemented and performed as indicated in Resident #2's service plan. |
Report Facts
Census: 33
Sample Size: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Executive Director | Executive Director | Interviewed regarding missing Universal Transfer Form and incident report; unable to provide completed UTF or incident report. |
| Licensed Practical Nurse #2 | Licensed Practical Nurse | Documented resident complaint related to the fall incident; no longer employed at the facility. |
| Licensed Practical Nurse #1 | Licensed Practical Nurse | Interviewed about safety checks, stated checks were done about every 15 minutes. |
Inspection Report
Original Licensing
Capacity: 68
Deficiencies: 0
Feb 23, 2022
Visit Reason
Initial licensing survey to assess compliance with New Jersey Administrative Code, Chapter 8:36, Standards for Licensure of Assisted Living Residences, Comprehensive Personal Care Homes, and Assisted Living Programs.
Findings
The facility was found to be in substantial compliance with applicable licensure standards based on this initial survey.
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