Deficiencies per Year
8
6
4
2
0
Severe
High
Moderate
Low
Unclassified
Census Over Time
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 details the types of information covered, reasons for use and disclosure of health information, individuals' rights to access and control their information, and NJDHSS's legal duties and responsibilities regarding privacy.
Report Facts
Effective date of notice: 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
Routine
Census: 80
Deficiencies: 0
May 21, 2024
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the State Agency to assess compliance with infection control regulations and CDC recommended practices for COVID-19 preparation.
Findings
The facility was found to be in compliance with the New Jersey Administrative Code 8:36 infection control regulations standards and CDC recommended practices for COVID-19.
Report Facts
Sample size: 3
Inspection Report
Complaint Investigation
Census: 81
Deficiencies: 4
Apr 29, 2024
Visit Reason
The inspection was conducted as a complaint investigation based on complaints NJ00161812 and NJ001622455 regarding the facility's compliance with New Jersey Administrative Code 8:36 standards for Assisted Living Residences.
Findings
The facility was found not in substantial compliance due to failure to develop and implement policies for notification and documentation of incidents, failure to maintain documented evidence of notification to responsible parties and healthcare providers after an incident involving Resident #1, failure to ensure initial physician certification for Resident #1, and failure to maintain documentation of overnight services provided to Resident #1.
Complaint Details
Complaint investigation based on complaints NJ00161812 and NJ001622455. The complaint involved failure to notify and document incidents, lack of physician certification, and inadequate documentation of care for Resident #1.
Deficiencies (4)
| Description |
|---|
| Failure to develop a policy and procedure including notification of Responsible Party, Physician, and Registered Nurse and documentation of such notification in medical records for Resident #1. |
| Failure to maintain documented evidence in the resident's medical record that the Responsible Party, Physician, and Registered Nurse were notified after the reported occurrence for Resident #1. |
| Failure to ensure that all residents received an initial physician certification to confirm that the resident's needs could be met in an Assisted Living Facility for Resident #1. |
| Failure to maintain documentation of services provided according to standards of professional practice and provide documented evidence that overnight services were performed for Resident #1. |
Report Facts
Sample size: 3
Inspection Report
Complaint Investigation
Census: 101
Deficiencies: 8
Apr 27, 2023
Visit Reason
Complaint investigation NJ00161102 regarding the facility's failure to comply with standards for licensure of assisted living residences, including monitoring residents' weight and notifying physicians and responsible parties of changes.
Findings
The facility was found deficient in monitoring residents' weight changes, notifying physicians and responsible parties of significant weight loss, updating resident care plans, reassessing residents after hospitalizations, ensuring presence of a Food Service Coordinator working with a dietitian, consulting dietitians for residents with weight loss, and sending completed Universal Transfer Forms with residents transferred to hospitals.
Complaint Details
Complaint NJ00161102 related to failure to comply with licensure standards including monitoring weight loss, notifying responsible parties, updating care plans, reassessing post-hospitalization, dietitian consultation, and transfer documentation.
Deficiencies (8)
| Description |
|---|
| Failure to implement and enforce policy for monitoring residents' weight changes and notifying physicians. |
| Failure to maintain documented evidence that Responsible Party was notified of change in condition for Resident #2. |
| Failure to update Resident Functional Needs Service Plan timely for Residents #2, #5, and #6 to address dietary and nutritional interventions. |
| Failure to reassess residents upon return from hospitalization for Residents #2, #3, #4, and #5. |
| Failure to designate a Food Service Coordinator present at the facility and working with a dietitian. |
| Failure to consult a dietitian to assess nutritional needs for Residents #2, #5, and #6 who sustained weight loss. |
| Failure to send a completed Universal Transfer Form with residents transferred to local emergency room for Residents #2, #3, #4, and #5. |
| Failure to develop and implement written policies and procedures addressing the required use of the Universal Transfer Form. |
Report Facts
Census: 101
Sample Size: 6
Audit Sample Percentage: 17
Completion Dates: Multiple corrective action completion dates ranging from May 1, 2023 to June 14, 2023
Inspection Report
Routine
Census: 92
Deficiencies: 0
Jan 12, 2023
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the State Agency to assess compliance with infection control regulations and CDC recommended practices.
Findings
The facility was found to be in compliance with New Jersey Administrative Code 8:36 infection control regulations and CDC recommended practices for COVID-19 preparation.
Report Facts
Census: 92
Inspection Report
Abbreviated Survey
Census: 86
Deficiencies: 0
Jan 28, 2021
Visit Reason
A Covid-19 Focused Infection Control Survey was conducted by the State Agency to assess compliance with New Jersey Administrative Code 8:36 infection control regulations and CDC recommended practices for COVID-19 preparation.
Findings
The facility was found to be in compliance with the infection control regulations and CDC recommended practices for COVID-19.
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