Inspection Reports for Mira Vie at Forsgate
319 Forsgate Dr, Monroe Township, NJ 08831, United States, NJ, 08831
Back to Facility ProfileDeficiencies per Year
8
6
4
2
0
Unclassified
Census Over Time
Notice
Deficiencies: 0
Nov 20, 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 details the types of information covered, the circumstances under which health information may be used or disclosed, the rights of individuals 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: 96
Deficiencies: 3
Jan 8, 2025
Visit Reason
The inspection was conducted as a complaint investigation based on complaints NJ00178721 and NJ00180129 regarding compliance with New Jersey Administrative Code 8:36 for Assisted Living Residences.
Findings
The facility was found not in substantial compliance with standards, specifically failing to ensure the implementation and enforcement of policies related to Service Plans and Health Service Plans for residents. Deficiencies were noted in the development, review, and updating of these plans for multiple residents.
Complaint Details
Complaint numbers NJ00178721 and NJ00180129 triggered the investigation. The complaint was substantiated as deficiencies were found in the facility's compliance with required policies and procedures.
Deficiencies (3)
| Description |
|---|
| Administrator failed to ensure implementation and enforcement of facility policy on Service Plans regarding Health Service Plans for 3 of 5 residents reviewed. |
| Facility failed to ensure that a Health Service Plan was developed based on the health care assessment for 1 of 5 residents reviewed. |
| Facility failed to ensure that a Health Service Plan was reviewed, revised quarterly, and as needed for 2 of 5 residents reviewed. |
Report Facts
Census: 96
Sample Size: 5
Inspection Report
Routine
Census: 104
Deficiencies: 0
Jun 27, 2024
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the State Agency to assess compliance with New Jersey Administrative Code 8:36 infection control regulations and CDC recommended practices.
Findings
The facility was found to be in compliance with the infection control regulations and CDC recommended practices to prepare for COVID-19.
Report Facts
Sample Size: 3
Inspection Report
Complaint Investigation
Census: 100
Deficiencies: 5
Jun 17, 2024
Visit Reason
The inspection was conducted as a complaint investigation (Complaint #NJ00166945) due to concerns about the facility's compliance with New Jersey Administrative Code 8:36 standards for licensure of assisted living residences.
Findings
The facility was found not in substantial compliance with licensure standards, specifically failing to provide access to residents' medical records, failing to ensure proper approval for facility name change, and deficiencies in resident assessments and care plans. The facility also failed to maintain resident medical records for surveyor review, impeding investigation.
Complaint Details
Complaint #NJ00166945 involved investigation of failure to provide medical records and facility documents, failure to update resident assessments and care plans, and failure to obtain proper licensing approval for facility name change.
Deficiencies (5)
| Description |
|---|
| Failure to provide residents' medical records and pertinent facility documents for review, impeding investigation. |
| Failure to ensure final approval from the Division of Certificate of Need and Licensing before changing the facility name. |
| Failure to ensure resident assessment reflected change of condition for Resident #2. |
| Failure to update resident's Plan of Care to include behaviors during staff care for Resident #2. |
| Failure to maintain and provide resident medical records for surveyor review for Resident #2. |
Report Facts
Census: 100
Sample Size: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Director of Nursing (DON) | Interviewed regarding access to medical records and resident assessments |
| Executive Director | Executive Director (ED) | Interviewed regarding access to medical records, facility licensing, and corrective actions |
| Regional Director of Nursing | Regional Director of Nursing (RDON) | Interviewed regarding Resident #2's incident and record access |
| Care Partner #1 | Care Partner | Interviewed regarding Resident #2's care and behaviors |
| Care Partner #2 | Care Partner | Interviewed regarding Resident #2's care and behaviors |
| Certified Medication Aide | Certified Medication Aide (CMA) | Interviewed regarding Resident #2's care |
Inspection Report
Complaint Investigation
Census: 115
Deficiencies: 0
Nov 14, 2022
Visit Reason
The inspection was conducted as a complaint investigation based on complaints NJ 00159229 and NJ 00159237.
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, based on this complaint survey.
Complaint Details
Complaint numbers NJ 00159229 and NJ 00159237 were investigated; the facility was found in substantial compliance.
Report Facts
Sample size: 3
Inspection Report
Complaint Investigation
Census: 98
Deficiencies: 3
Nov 12, 2021
Visit Reason
The inspection was conducted as a complaint investigation related to allegations of staff to resident abuse and failure to comply with resident rights and reporting requirements at Chelsea at Forsgate, an assisted living facility.
Findings
The facility was found not in substantial compliance with New Jersey Administrative Code standards due to failure to immediately notify the Executive Director of suspected abuse, failure to document incidents in resident records, verbal abuse by a Certified Medication Aide (CMA) toward a resident, and failure to report the alleged verbal abuse to the Department of Health. The resident reported verbal abuse including being called derogatory names by CMA #1. The facility delayed investigation and did not protect the resident promptly. The Executive Director did not report the verbal abuse to the Department of Health as required.
Complaint Details
Complaint #: NJ 00149585. The complaint involved allegations of staff to resident physical and verbal abuse. The Executive Director was not notified immediately of the verbal abuse incident, delaying investigation and resident protection. The verbal abuse was substantiated by resident and staff interviews. The facility failed to report the verbal abuse to the Department of Health.
Deficiencies (3)
| Description |
|---|
| Administrator failed to implement and enforce the facility policy for prevention of abuse, including failure to immediately notify the Executive Director of suspected abuse, failure to develop policy addressing staff to resident abuse, and failure to document the incident in the resident's record. |
| Facility staff failed to communicate with resident in a dignified and respectful manner; CMA #1 verbally abused resident by yelling and calling the resident derogatory names. |
| Facility failed to notify the Department of Health immediately of suspected staff to resident verbal abuse as required by regulation. |
Report Facts
Census: 98
Sample Size: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| CMA #1 | Certified Medication Aide | Named in verbal abuse incident toward resident, including yelling and calling resident derogatory names. |
| Executive Director | Executive Director (ED) | Failed to be notified immediately of suspected abuse and failed to report verbal abuse to Department of Health. |
| Registered Nurse | Registered Nurse (RN) | Interviewed regarding abuse incident and confirmed CMA #1 was not supposed to medicate the resident after the incident. |
| Director of Nursing | Director of Nursing (DON) | Spoke with resident about abuse incident and confirmed resident's preference that CMA #1 no longer provide care. |
| CMA #2 | Certified Medication Aide | Received complaint call from resident's sibling about CMA #1's behavior but did not report incident to management. |
| Activity Director | Activity Director (AD) | Informed Executive Director of verbal abuse complaint from resident's family. |
Inspection Report
Complaint Investigation
Census: 90
Deficiencies: 0
Mar 15, 2021
Visit Reason
The inspection was conducted as a complaint survey based on complaints NJ 136466, NJ 00132090, and NJ 00141069.
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 based on this complaint survey.
Complaint Details
Complaint numbers NJ 136466, NJ 00132090, and NJ 00141069 were investigated during this complaint survey.
Report Facts
Sample size: 5
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