Inspection Reports for Bear Creek Assisted Living

291 Village Rd E, West Windsor Township, NJ 08550, United States, NJ, 08550

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Notice Deficiencies: 0 Nov 19, 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
NameTitleContext
Devon L. GrafDirector, NJDHSS Privacy OfficerContact person for privacy practices and rights
Inspection Report Complaint Investigation Census: 87 Deficiencies: 2 Jun 4, 2025
Visit Reason
The inspection was conducted as a complaint survey in response to Complaint #NJ00186735 to investigate concerns related to resident safety and record availability at Bear Creek Assisted Living.
Findings
The facility was found not in substantial compliance with New Jersey Administrative Code standards, with deficiencies including failure to ensure a safe environment for residents in the Memory Care Community and failure to provide full access to Electronic Medical Records for Department of Health surveyors.
Complaint Details
Complaint #NJ00186735 was substantiated as the facility failed to meet resident safety requirements and record availability standards during the complaint investigation.
Deficiencies (2)
Description
Failure to ensure Memory Care Community staff provide a safe environment for residents, including proper supervision and removal of removable chairs in the courtyard.
Failure to ensure full access to Electronic Medical Records for Department of Health surveyors upon request.
Report Facts
Census: 87 Sample Size: 3
Employees Mentioned
NameTitleContext
Director of NursingDirector of Nursing (DON)Accompanied surveyor during investigation and provided information about facility policies and resident supervision
Inspection Report Complaint Investigation Census: 87 Deficiencies: 2 Aug 15, 2024
Visit Reason
The inspection was conducted as a complaint investigation (Complaint #NJ00170652) to determine compliance with New Jersey Administrative Code 8:36 standards for licensure of assisted living residences.
Findings
The facility was found not in substantial compliance due to failure to consistently implement policies and procedures related to emergency response, specifically failing to notify the family or designated responsible party of a resident's transfer to the hospital for 1 of 5 residents reviewed (Resident #3).
Complaint Details
Complaint #NJ00170652 was substantiated based on observation, interview, and record review showing failure to notify Resident #3's family Power of Attorney of the hospital transfer.
Deficiencies (2)
Description
Failure to consistently implement policies and procedures related to emergency response and notification of family or responsible party of a hospital transfer for Resident #3.
Failure to ensure immediate notification of family, guardian, or designated responsible party of a resident transfer from the facility to the hospital for Resident #3.
Report Facts
Census: 87 Sample Size: 5
Employees Mentioned
NameTitleContext
Executive DirectorExecutive DirectorInterviewed regarding notification procedures and family visits related to Resident #3
Director of WellnessDirector of WellnessInterviewed regarding emergency notification policies and procedures
Inspection Report Complaint Investigation Census: 86 Deficiencies: 3 Jan 3, 2024
Visit Reason
The inspection was conducted as a complaint investigation (Complaint # NJ00165130) to determine compliance with New Jersey Administrative Code standards related to licensure and care procedures at Bear Creek Assisted Living.
Findings
The facility failed to retain completed copies of the Universal Transfer Form for 3 of 4 residents transferred to the hospital. Additionally, the facility did not provide documented evidence that the Registered Nurse or the Physician was notified when 2 of 4 residents were transferred to the hospital for evaluation.
Complaint Details
Complaint # NJ00165130 involved allegations that the facility failed to retain Universal Transfer Forms and failed to notify the Registered Nurse and Physician when residents were transferred to the hospital. The complaint was substantiated based on interviews and record reviews.
Deficiencies (3)
Description
Failure to retain a completed copy of the Universal Transfer Form for residents transferred to the hospital.
Failure to provide documented evidence that the Registered Nurse was notified at the onset of illness, injury, or change in condition for residents transferred to the hospital.
Failure to provide documented evidence that the Physician was notified of significant changes and hospital transfers for residents.
Report Facts
Residents reviewed: 4 Residents with missing Universal Transfer Forms: 3 Residents without documented RN notification: 2 Residents without documented Physician notification: 2

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