Inspection Reports for
Carnegie Post Acute Care At Princeton Llc

Complaint numbers 2624594, 2593784, 2584559 were investigated. The facility was found to have delayed wound care treatment for Resident #5, and the nursing home is disputing this citation.

The facility failed to initiate wound care treatment as recommended for three days for Resident #5, resulting in a delay from 7/24/25 to 7/27/25. The facility did not follow its wound care policy and delayed treatment despite physician recommendations.

The facility was found deficient in multiple areas including comprehensive resident assessments, accuracy of assessments, physician visit frequency, psychotropic medication use, infection prevention and control, staffing ratios, and life safety code compliance. Plans of correction were submitted and accepted with completion dates in April 2025.

Complaint NJ 00179151 involved allegations of inaccurate resident assessments, failure to ensure required physician visits, and improper use of psychotropic medications. The complaint was substantiated with findings related to Residents #5, #43, and #53.

The facility failed to accurately complete the Minimum Data Set (MDS) assessments for 3 residents, failed to ensure required monthly face-to-face physician visits for 1 resident, and failed to ensure adequate indication for antipsychotic medication use for 1 resident. Deficiencies were noted in documentation accuracy, physician visit frequency, and psychotropic medication justification.

Complaint # NJ 00179151 involved issues with MDS accuracy, physician visits, psychotropic medication use, infection prevention, and antibiotic stewardship.

The facility was found deficient in timely and accurate completion of MDS assessments, failure to ensure required physician visits, inappropriate use of antipsychotic medication without proper diagnosis, inadequate infection prevention practices including lack of proper PPE for laundry staff, failure to maintain an ongoing antibiotic stewardship program, and lack of a designated full-time Infection Preventionist onsite.

Complaint investigation based on allegations NJ00178815 and NJ00178967. The complaint was substantiated as the facility failed to report alleged abuse and neglect timely and did not meet staffing requirements. The investigation included interviews, document reviews, and policy assessments.

The facility was found not in substantial compliance with 42 CFR Part 483, Subpart B, based on failure to report alleged violations of abuse and neglect timely and failure to maintain required staffing ratios for Certified Nurse Aides (CNAs) on multiple day shifts.

Complaint #NJ00178967 involved an allegation that a resident was restrained by having her legs tied up. The allegation was investigated and found unsubstantiated. The resident uses TED stockings which explained the reported tightness. The facility did not report the allegation to the New Jersey Department of Health as required. Notification to the Ombudsman was made and ongoing.

The investigation concluded that no restraints had been applied to the resident; the tightness reported was due to TED stockings worn as per medical orders. However, the facility failed to timely report the allegation to the New Jersey Department of Health as required by policy.

Complaint numbers NJ00152846 and NJ00169811 were investigated. The facility was found deficient in staffing ratios but was in compliance with 42 CFR Part 483, Subpart B based on this complaint survey.

The facility was found not in compliance with New Jersey Administrative Code 8:39 standards for licensure of Long Term Care Facilities due to failure to maintain required minimum staff-to-resident ratios on 17 of 28 day shifts. The facility submitted a plan of correction and was required to ensure staffing ratios met state mandates.

Complaint numbers NJ00146686 and NJ00150785 triggered the survey. The facility was found not in substantial compliance based on these complaints.

The facility was found not in substantial compliance with requirements due to failure to consistently document Activities of Daily Living (ADL) care for multiple residents and failure to maintain required minimum staff-to-resident ratios for certified nursing assistants (CNAs) on numerous day shifts.

Complaint #NJ00146686 regarding inconsistent documentation of ADL care for residents. The complaint was substantiated based on observations, interviews, and record reviews.

The surveyor found that facility staff failed to document ADL care consistently for 4 of 4 residents reviewed, with multiple dates and shifts lacking documentation. Interviews with staff confirmed documentation was mandatory but not consistently completed, especially during night shifts.

The facility was found deficient in multiple areas including failure to provide timely notification of emergency transfers and bed-hold policy to residents and representatives, incomplete comprehensive care plans addressing pain, dementia, wounds, and antibiotic use, medication administration errors including improper crushing and documentation, failure to maintain medication availability and proper labeling, inadequate food temperature control, inconsistent provision of bedtime snacks, incomplete attendance of infection control personnel at QAPI meetings, and lapses in infection control practices including hand hygiene and proper disposal of soiled items.

Complaint #: NJ00159874. The facility was found deficient in staffing ratios and RN coverage based on review of staffing reports and interviews during the complaint survey.

The facility was found not in substantial compliance with federal and state staffing requirements, specifically failing to maintain minimum direct care staff-to-resident ratios and required Registered Nurse staffing for multiple days during the review period.

The facility was found not to be in compliance with infection control regulations, specifically failing to ensure proper hand hygiene, appropriate use of personal protective equipment (PPE), and correct donning of PPE prior to entering rooms of residents on Transmission Based Precautions. Multiple staff members, including nursing and housekeeping staff as well as physicians, were observed not following required infection control practices.

The facility was found deficient in developing timely and complete care plans for residents using oxygen and fall interventions, transcribing physician orders for oxygen to electronic records, checking enteral feeding tube placement prior to feeding, labeling and dating multi-use water jugs for tube flush, maintaining medication carts free of expired and unmarked medications, and properly labeling and dating dry food items in the kitchen.