Inspection Reports for Complete Care At Kresson View, Llc
2601 Evesham Road, NJ, 08043
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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
| 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: 220
Deficiencies: 1
Aug 22, 2024
Visit Reason
The inspection was conducted based on a complaint (NJ00175034) to determine compliance with federal and state regulations for long term care facilities.
Findings
The facility was found not in compliance with New Jersey Administrative Code 8:39 due to failure to meet required minimum staff-to-resident ratios for Certified Nursing Assistants (CNAs) during multiple day and evening shifts over several weeks. The facility was deficient in CNA staffing on 28 day shifts and 2 evening shifts as mandated by state law.
Complaint Details
Complaint #: NJ00175034. The facility was found deficient in CNA staffing for 28 day shifts and 2 evening shifts during the periods 06/16/2024 to 06/29/2024 and 08/04/2024 to 08/17/2024. Residents affected were monitored with no adverse effects noted.
Deficiencies (1)
| Description |
|---|
| Failure to ensure staffing ratios were met to maintain the required minimum staff-to-resident ratio as mandated by the State of New Jersey. |
Report Facts
Census: 220
Deficient CNA staffing shifts: 28
Deficient total staff evening shifts: 2
Required CNA to resident ratios: 8
Required staff to resident ratios: 10
Required staff to resident ratios: 14
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Administrator | Named as part of the team reviewing staffing and attending Labor Management Meetings. | |
| Director of Nursing | Named as part of the team reviewing staffing and filling open CNA shifts. | |
| Assistant Director of Nursing | Named as part of the team reviewing staffing and filling open CNA shifts. | |
| Human Resources Manager | Named as part of the team reviewing staffing and attending Labor Management Meetings. | |
| Scheduling Manager | Named as part of the team reviewing staffing and attending Labor Management Meetings. | |
| Unit Managers | Named as part of the team filling open CNA shifts. | |
| RN Supervisors | Named as part of the team filling open CNA shifts. | |
| Licensed Nurses | Named as part of the team filling open CNA shifts. |
Inspection Report
Complaint Investigation
Census: 212
Deficiencies: 1
Nov 20, 2023
Visit Reason
The inspection was conducted as a complaint survey based on multiple complaints (NJ150953, NJ151583, NJ155641, NJ168428) to determine compliance with long term care facility regulations.
Findings
The facility was found not in compliance with New Jersey Administrative Code standards due to failure to meet required minimum staffing ratios for Certified Nurse Aides (CNAs) on 14 of 14 day shifts and deficient total staff on 1 of 14 overnight shifts. No specific residents were affected by this deficient practice.
Complaint Details
The complaint investigation involved multiple complaint numbers (NJ150953, NJ151583, NJ155641, NJ168428). The facility was found deficient in staffing ratios for all day shifts reviewed and one overnight shift. The deficient practice had the potential to affect all residents. No specific residents were identified as affected.
Deficiencies (1)
| Description |
|---|
| The facility failed to ensure staffing ratios were met to maintain the required minimum staff-to-resident ratio as mandated by the State of New Jersey. |
Report Facts
Census: 212
Sample Size: 6
Deficient CNA staffing days: 14
Deficient total staff overnight shifts: 1
Required CNAs on 11/05/23 day shift: 27
Actual CNAs on 11/05/23 day shift: 14
Required total staff on 11/05/23 overnight shift: 15
Actual total staff on 11/05/23 overnight shift: 14
Required CNAs on 11/06/23 day shift: 27
Actual CNAs on 11/06/23 day shift: 19
Required CNAs on 11/07/23 day shift: 26
Actual CNAs on 11/07/23 day shift: 19
Required CNAs on 11/08/23 day shift: 26
Actual CNAs on 11/08/23 day shift: 23
Required CNAs on 11/09/23 day shift: 26
Actual CNAs on 11/09/23 day shift: 23
Required CNAs on 11/10/23 day shift: 26
Actual CNAs on 11/10/23 day shift: 20
Required CNAs on 11/11/23 day shift: 26
Actual CNAs on 11/11/23 day shift: 18
Required CNAs on 11/12/23 day shift: 26
Actual CNAs on 11/12/23 day shift: 16
Required CNAs on 11/13/23 day shift: 26
Actual CNAs on 11/13/23 day shift: 16
Required CNAs on 11/14/23 day shift: 26
Actual CNAs on 11/14/23 day shift: 18
Required CNAs on 11/15/23 day shift: 26
Actual CNAs on 11/15/23 day shift: 22
Required CNAs on 11/16/23 day shift: 26
Actual CNAs on 11/16/23 day shift: 20
Required CNAs on 11/17/23 day shift: 26
Actual CNAs on 11/17/23 day shift: 19
Required CNAs on 11/18/23 day shift: 26
Actual CNAs on 11/18/23 day shift: 21
Inspection Report
Complaint Investigation
Census: 223
Deficiencies: 1
Mar 20, 2023
Visit Reason
The inspection was conducted based on a complaint survey (Complaint # NJ00162198) to investigate allegations of abuse at the facility.
Findings
The facility was found not in compliance with requirements related to reporting alleged violations of abuse. Specifically, the facility failed to report allegations of abuse immediately to the Administrator and notify the New Jersey Department of Health for one sampled resident. Interviews and record reviews confirmed delays and failures in reporting and investigating abuse allegations.
Complaint Details
Complaint # NJ00162198 involved allegations of abuse for Resident #4. The facility failed to report the abuse allegations immediately and did not notify the NJ Department of Health as required. Interviews with residents, CNAs, Human Resources Manager, Director of Nursing, and Administrator confirmed the failure to timely report and investigate the allegations. The facility implemented re-education and corrective actions starting 03/16/2023.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to report allegations of abuse immediately to the Administrator and notify the New Jersey Department of Health according to policy for one resident. | SS=D |
Report Facts
Census: 223
Sample Size: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Certified Nurse Aide #1 | CNA | Named in abuse allegation involving Resident #4 |
| Certified Nurse Aide #2 | CNA | Reported Resident #4's complaint and confirmed conflict with CNA #1 |
| Human Resources Manager | HRM | Received complaints about CNA #1's attitude and failed to report allegations immediately |
| Director of Nursing | DON | Confirmed no abuse allegations were reported to her by staff |
| Administrator | Administrator | Responsible for abuse reporting and investigation; interviewed Resident #4 and staff |
Document
Deficiencies: 0
Nov 21, 2021
Visit Reason
This document does not contain any inspection or regulatory information; it is a prompt to open the PDF portfolio with compatible software.
Findings
No findings or inspection content is present in this document.
Document
Deficiencies: 0
Sep 7, 2021
Visit Reason
This document is not an inspection or regulatory report but a prompt to open the PDF portfolio in a compatible reader.
Findings
No inspection or regulatory findings are present in this document.
Inspection Report
Life Safety
Deficiencies: 1
Sep 1, 2021
Visit Reason
A Life Safety Code Survey was conducted by the New Jersey Department of Health on 09/01/21 and 09/03/21 to assess compliance with Medicare/Medicaid participation requirements and the 2012 Edition of the National Fire Protection Association (NFPA) 101, Life Safety Code.
Findings
The facility was found to be in noncompliance due to failure to ensure that two illuminated exit signs were posted to clearly identify the exit access path above the enclosed center courtyard doors. The deficiency was observed during a facility tour in the presence of the Maintenance Director.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to ensure that two illuminated exit signs were posted to clearly identify the exit access path above the enclosed center courtyard doors. | SS=D |
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance Director | Present during observation of deficient exit signage | |
| Administrator | Informed of findings during Life Safety Code survey exit conference |
Inspection Report
Routine
Census: 158
Deficiencies: 0
Apr 30, 2021
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the New Jersey Department of Health to assess compliance with infection control regulations related to COVID-19.
Findings
The facility was found to be in compliance with 42 CFR §483.80 infection control regulations and has implemented the CMS and CDC recommended practices for COVID-19.
Report Facts
Sample size: 3
Inspection Report
Complaint Investigation
Census: 156
Deficiencies: 0
Mar 18, 2021
Visit Reason
The inspection was conducted as a complaint investigation based on complaint # NJ 143446.
Findings
The facility was found to be in substantial compliance with the requirements of 42 CFR Part 483, Subpart B, for long term care facilities based on this complaint visit.
Complaint Details
Complaint # NJ 143446 was investigated and the facility was found to be in substantial compliance.
Report Facts
Sample size: 4
Inspection Report
Routine
Census: 173
Deficiencies: 0
Feb 3, 2021
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the New Jersey Department of Health to assess compliance with infection control regulations.
Findings
The facility was found to be in compliance with 42 CFR §483.80 infection control regulations and has implemented the CMS and CDC recommended practices for COVID-19.
Report Facts
Sample size: 8
Inspection Report
Complaint Investigation
Census: 182
Deficiencies: 0
Jan 14, 2021
Visit Reason
The inspection was conducted as a complaint investigation identified as Complaint # NJ142363.
Findings
The facility was found to be in substantial compliance with the requirements of 42 CFR Part 483, Subpart B, for long term care facilities based on this complaint visit.
Complaint Details
Complaint # NJ142363 was investigated and the facility was found to be in substantial compliance.
Report Facts
Sample size: 5
Inspection Report
Routine
Census: 182
Deficiencies: 0
Jan 14, 2021
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the New Jersey Department of Health to assess compliance with infection control regulations.
Findings
The facility was found to be in compliance with 42 CFR §483.80 infection control regulations and has implemented the CMS and CDC recommended practices for COVID-19.
Report Facts
Sample size: 5
Inspection Report
Routine
Census: 177
Deficiencies: 0
Dec 28, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the New Jersey Department of Health to assess compliance with infection control regulations and recommended COVID-19 practices.
Findings
The facility was found to be in compliance with 42 CFR §483.80 infection control regulations and had implemented the CMS and CDC recommended practices for COVID-19.
Report Facts
Sample size: 8
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