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
Routine
Census: 122
Deficiencies: 0
Sep 15, 2023
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the State Agency to assess compliance with infection control regulations and CDC recommended practices related to COVID-19.
Findings
The facility was found to be in compliance with the New Jersey Administrative Code 8:36 infection control regulations standards and CDC recommended practices for COVID-19 preparation.
Report Facts
Sample Size: 3
Inspection Report
Complaint Investigation
Census: 115
Deficiencies: 2
Jun 12, 2023
Visit Reason
The inspection was conducted as a complaint investigation (Complaint # NJ00164353) due to concerns about the facility's compliance with policies and procedures, specifically regarding incident reporting and resident assessments.
Findings
The facility was found not in substantial compliance with New Jersey Administrative Code standards due to failure to complete an incident report for one resident and failure to notify a Registered Nurse of a suspected condition requiring timely assessment for the same resident.
Complaint Details
Complaint # NJ00164353 involved allegations that the facility did not execute its incident reporting policy and failed to notify the RN of a suspected condition for Resident #2. The complaint was substantiated by interviews and record reviews.
Deficiencies (2)
| Description |
|---|
| Failure to complete an incident report for 1 of 3 residents (Resident #2) as required by facility policy. |
| Failure to notify a Registered Nurse of a suspected condition to ensure timely assessment for 1 of 3 residents (Resident #2). |
Report Facts
Census: 115
Sample Size: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Wellness Director | Interviewed regarding incident report documentation | |
| Licensed Practical Nurse (LPN) | Interviewed about incident and failure to document or notify RN | |
| Registered Nurse (RN) | Interviewed about being on-call and not notified of incident |
Inspection Report
Routine
Census: 89
Deficiencies: 0
Nov 10, 2022
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the State Agency to assess compliance with infection control regulations and CDC recommended practices related to COVID-19.
Findings
The facility was found to be in compliance with the New Jersey Administrative Code 8:36 infection control regulations standards and CDC recommended practices for COVID-19 preparation.
Inspection Report
Complaint Investigation
Census: 81
Deficiencies: 0
Aug 11, 2022
Visit Reason
The inspection was conducted as a complaint investigation based on complaint number NJ150940.
Findings
The facility was found to be in substantial compliance with New Jersey Administrative Code, Chapter 8:36, Standards for Licensure of Assisted Living Residences, Comprehensive Personal Care Homes, and Assisted Living Programs.
Complaint Details
Complaint number NJ150940 was investigated and the facility was found to be in substantial compliance.
Report Facts
Sample size: 7
Inspection Report
Abbreviated Survey
Census: 64
Deficiencies: 0
Nov 19, 2020
Visit Reason
A Covid-19 Focused Infection Control Survey was conducted by the State Agency to assess compliance with infection control regulations and CDC recommended practices related to COVID-19.
Findings
The facility was found to be in compliance with the New Jersey Administrative Code 8:36 infection control regulations standards for licensure of assisted living residences and CDC recommended practices to prepare for COVID-19.
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