Inspection Reports for Grove Park Healthcare and Rehabilitation Center

The complaint involved a resident reporting that a friend who worked for a transportation company gave them a marijuana brownie. The facility contacted the transportation company, which denied having a driver by the name provided by the resident. The facility then ended the investigation.

The facility failed to fully investigate and implement measures to address the allegation after the transportation company denied having a driver matching the name provided by the resident, leading the facility to end the investigation prematurely.

The facility was found deficient in multiple areas including failure to treat residents with dignity by posting menus in rooms of NPO residents, inaccurate MDS assessments, failure to document NPO intake properly, inconsistent application and documentation of splints and heel booties, delayed nutritional evaluations, inadequate pain assessments, lack of monitoring for psychotropic medication side effects, failure to provide nourishing bedtime snacks consistently, and improper kitchen sanitation practices.

Complaint investigation was part of the recertification survey with complaint numbers NJ177873, NJ173448, NJ171562, NJ170363, NJ169371.

The facility was found to have multiple deficiencies including failure to ensure residents' rights and dignity, accuracy of assessments, professional standards in services provided, mobility support, nutrition and hydration status maintenance, pain management, psychotropic medication monitoring, and life safety code violations related to fire safety and emergency preparedness.

The facility was found deficient in multiple areas including failure to provide Saturday mail delivery, incomplete license verification for newly hired CNAs, inadequate investigation and documentation of resident incidents and falls, inaccurate Minimum Data Set (MDS) coding, failure to follow physician orders for oxygen and x-rays, improper handling of medications and linens, failure to offer pneumonia vaccination, and lapses in infection control practices including water management and tracheostomy care.

The facility was found not in compliance with several federal regulations including issues with resident rights, staff qualifications, care planning, infection control, medication management, and safety. Multiple deficiencies were cited related to resident care, staff training, and facility policies.

The complaint investigation revealed failures in incident investigation, documentation, supervision, and behavior monitoring for multiple residents, including Resident #95's fall with hematoma, Resident #24's altercation with Resident #270, and supervision of Resident #162 at risk for elopement.

The facility failed to thoroughly investigate and document incidents, including a fall resulting in a hematoma for Resident #95, and a resident-to-resident altercation involving Resident #24. The investigation and documentation were incomplete, with missing staff statements and inconsistent reporting. Behavior monitoring orders were unclear and not properly clarified. The facility also failed to ensure adequate supervision for a cognitively impaired resident at risk for elopement. The facility policies lacked clarity on documentation requirements and investigation procedures.

The complaint investigation was based on four complaint numbers (NJ00153969, NJ00154606, NJ00154326, NJ00154860). The facility was found not in substantial compliance with regulatory requirements during this complaint visit.

The facility was found not in substantial compliance with 42 CFR Part 483, Subpart B, specifically regarding the failure to perform comprehensive assessments upon admission or readmission for residents. The deficiency related to the governing body's responsibility to ensure proper management and operation was cited.

Deficiencies were identified related to Activities of Daily Living (ADL) care, Respiratory/Tracheostomy Care and Suctioning, Pharmacy Services, Medication Administration, Infection Control, and Life Safety Code compliance. The facility was found not in compliance with several regulatory requirements.

The facility was found deficient in multiple areas including failure to provide regular nail care, improper respiratory care and oxygen management, medication administration errors including dialysis medication timing and hold parameters, medication error rate exceeding 5%, improper infection control practices including PPE use and hand hygiene, unsanitary trash disposal, and inadequate monitoring of residents during a COVID-19 outbreak.

Complaint investigation based on allegations of verbal abuse and mistreatment of Resident #2 by three staff members. Resident reported feeling targeted, bullied, embarrassed, and unsafe. Incidents involved name-calling, profanity, and unprofessional conduct. Facility failed to report incidents timely and conduct thorough investigations.

The facility was found not in substantial compliance with requirements related to abuse and neglect. Resident #2 reported multiple incidents of verbal abuse and unprofessional behavior by staff. The facility failed to conduct thorough investigations and timely report these incidents to the New Jersey Department of Health. Staff were verbally counseled but documentation and formal corrective actions were lacking. The Administrator did not fully follow facility policies or regulatory requirements for abuse investigation and reporting.

The facility was found not in compliance with infection control regulations, specifically failing to provide services utilizing accepted infection control practices during food and drink service by Activity Aides. Deficiencies included improper hand hygiene and uncovered drink cups.

Complaint # NJ 141738 and NJ 141847 involved allegations of resident-to-resident abuse by Resident #1. The investigation found that Resident #1 was left unattended by the assigned CNA and was able to enter another resident's room and engage in inappropriate behavior. The Immediate Jeopardy was identified on 12/18/2020 and was past non-compliance from 12/15/2020 10:15 a.m. to 12/15/2020 12:00 p.m. The facility provided an acceptable Removal Plan including staff in-servicing and 1:1 supervision.

The facility failed to ensure that Resident #1, who had a history of resident-to-resident abuse, was consistently monitored, resulting in Resident #1 entering another resident's room unsupervised and engaging in inappropriate behavior. The assigned CNA left Resident #1 unattended without coverage, violating facility policies and placing residents at immediate jeopardy. The facility implemented corrective actions including staff in-servicing and 1:1 supervision monitoring.