Inspection Reports for Job Haines Home
250 Bloomfield Ave, Bloomfield, NJ 07003, NJ, 07003
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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 the notice |
Inspection Report
Annual Inspection
Census: 39
Capacity: 40
Deficiencies: 4
Feb 22, 2023
Visit Reason
A Recertification Survey was conducted to determine compliance with 42 CFR Part 483, Requirements for Long Term Care Facilities.
Findings
Deficiencies were cited related to pharmacy services including failure to remove expired IV medication sets and improper execution of DEA Form 222. Additionally, a Life Safety Code survey found noncompliance with emergency lighting and generator manual stop station requirements.
Severity Breakdown
SS=D: 2
SS=F: 2
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to reconcile, identify and remove three expired intravenous medication supply sets in the medication cart on the subacute unit. | SS=D |
| Failed to ensure accurate execution of DEA Form 222, including not making a copy of the order form before sending to the pharmacy. | SS=D |
| Failed to provide battery-powered emergency lighting at the emergency generator transfer switch as required by NFPA 110. | SS=F |
| Failed to ensure the 50 KW diesel emergency generator had a remote manual stop station to prevent inadvertent operation. | SS=F |
Report Facts
Census: 39
Total Capacity: 40
Sample Size: 14
Deficiency Completion Date: Mar 17, 2023
Inspection Report
Routine
Census: 35
Deficiencies: 2
Mar 15, 2021
Visit Reason
Routine standard survey conducted to assess compliance with federal regulations for long term care facilities.
Findings
The facility was found not in substantial compliance with federal requirements, with deficiencies related to improper storage of controlled substances, unsanitary food preparation and storage practices, and expired nutritional supplements.
Severity Breakdown
SS=D: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to ensure controlled substances were stored in a manner to prevent loss or diversion; narcotic storage boxes in medication refrigerators were not permanently affixed. | SS=D |
| Failed to store potentially hazardous foods properly, maintain kitchen environment and equipment in a sanitary manner, and discard expired nutritional supplements. | SS=D |
Report Facts
Sample Size: 15
Expired nutritional supplement containers: 23
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Unit Manager Registered Nurse | Unit Manager Registered Nurse (UMRN) | Present during medication refrigerator inspection and acknowledged deficiencies. |
| Food Service Director | Food Service Director (FSD) | Present during food preparation area inspection and involved in corrective actions. |
| Director of Nursing | Director of Nursing (DON) | Informed of deficiencies and responsible for ongoing compliance monitoring. |
| Administrator | Administrator | Informed of deficiencies during survey. |
Inspection Report
Complaint Investigation
Census: 34
Deficiencies: 0
Dec 8, 2020
Visit Reason
The inspection was conducted as a complaint survey based on Complaint #: NJ00132628.
Findings
The facility was found to be in compliance with the requirements of 42 CFR Part 483, Subpart B, for Long Term Care Facilities based on this complaint survey.
Complaint Details
Complaint #: NJ00132628; the survey was complaint-based and the facility was found compliant.
Report Facts
Sample Size: 7
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