Inspection Reports for Mira Vie at Montville
165 Changebridge Rd, Montville, NJ 07045, United States, NJ, 07045
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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, reasons for use and disclosure of health information, individuals' rights to access and control their information, and legal duties of NJDHSS to protect privacy.
Report Facts
Effective date: 2011
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Devon L. Graf | Director, NJDHSS Privacy Officer | Contact person for privacy practices and rights |
Inspection Report
Complaint Investigation
Deficiencies: 3
Apr 8, 2024
Visit Reason
The inspection was conducted as a complaint investigation based on complaints NJ00172254 and NJ00156353 regarding 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 state standards due to failure to develop and implement a comprehensive record retention policy, inability to provide a closed medical record for a discharged resident, and failure of a registered nurse to accurately document resident care according to professional standards.
Complaint Details
Complaint investigation based on complaints NJ00172254 and NJ00156353. The facility was found deficient in record retention and documentation practices. Substantiation status is not explicitly stated.
Deficiencies (3)
| Description |
|---|
| Failure to ensure a comprehensive policy for record retention was developed and implemented according to state regulations for Resident #5. |
| Failure to provide the closed medical record of Resident #5 during the survey visit. |
| Registered Nurse failed to accurately document condition, treatment, and coordination of care for Resident #2 according to professional standards. |
Report Facts
Sample size: 3
Residents reviewed: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Executive Director | Executive Director | Unable to locate Resident #5's medical record; stated some boxes may have been inadvertently taken during ownership transition. |
| Vice President of Clinical Services | Vice President of Clinical Services | Provided record retention policy and stated facility was working with previous owners to access archived files. |
| Registered Nurse | Registered Nurse | Failed to accurately document resident condition, treatment, and coordination of care for Resident #2. |
| Director of Health and Wellness | Director of Health and Wellness | Provided partial medical record for Resident #5 during survey. |
Inspection Report
Routine
Census: 125
Deficiencies: 0
Nov 21, 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.
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: 120
Deficiencies: 0
May 31, 2023
Visit Reason
The inspection was conducted as a complaint investigation based on complaint number NJ00163097.
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 NJ00163097 was investigated and the facility was found to be in substantial compliance.
Report Facts
Sample size: 3
Inspection Report
Complaint Investigation
Census: 120
Deficiencies: 0
Mar 13, 2023
Visit Reason
The inspection was conducted as a complaint investigation based on complaints NJ00162292 and NJ00162264.
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 numbers NJ00162292 and NJ00162264 were investigated; the facility was in substantial compliance based on this complaint survey.
Report Facts
Sample size: 4
Inspection Report
Complaint Investigation
Census: 125
Deficiencies: 1
Jan 23, 2023
Visit Reason
The inspection was conducted as a COVID-19 Focused Infection Control Survey and a Complaint Investigation related to infection control practices at the facility.
Findings
The facility was found not to be in compliance with infection control regulations, specifically failing to ensure staff wore N95 respirator masks when caring for a COVID-19 positive resident, instead using KN95 masks. The facility was otherwise in substantial compliance with licensure standards.
Complaint Details
Complaint numbers NJ00160422 and NJ00160584 were investigated. The facility was found not in compliance with infection control standards related to mask usage for COVID-19 positive residents.
Deficiencies (1)
| Description |
|---|
| Facility failed to ensure staff wore N95 respirator masks when working with a COVID-19 positive resident, using KN95 masks instead. |
Report Facts
Census: 125
Sample Size: 3
Masks found: 40
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Len Polillo | Executive Director | Mentioned regarding difficulty obtaining N95 masks and discovery of masks in storage |
| Health Services Director | Stated facility did not require N95 masks and believed KN95 masks were equivalent | |
| Certified Medication Aide #1 | Indicated staff started wearing KN95 masks a week prior | |
| Certified Nursing Assistant #3 | Reported using KN95 mask when providing care to COVID-19 positive resident | |
| Certified Medication Aide #5 | Observed PPE supplies and stated she wore KN95 mask | |
| Certified Medication Aide #6 | Reported wearing KN95 mask when entering COVID-19 positive resident's apartment | |
| Home Health Aide #7 | Stated staff wore KN95 masks when providing care to COVID-19 positive residents |
Inspection Report
Complaint Investigation
Census: 102
Deficiencies: 0
Feb 25, 2021
Visit Reason
The inspection was conducted as a complaint survey based on Complaint # NJ 143162.
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 # NJ 143162 was investigated and the facility was found to be in substantial compliance.
Report Facts
Sample Size: 6
Inspection Report
Complaint Investigation
Census: 95
Deficiencies: 3
Feb 10, 2021
Visit Reason
The inspection was conducted in response to Complaint #NJ 142934 to assess compliance with New Jersey Administrative Code 8:36 for Assisted Living Residences.
Findings
The facility failed to maintain clear and unobstructed exit discharge paths for multiple designated exit doors, including one on the Memory Impaired unit and three of ten exit discharge doors overall, due to blocked doors and snow accumulation, placing residents at risk.
Complaint Details
Complaint #NJ 142934 was substantiated based on observations, interviews, and documentation review indicating blocked exit discharge paths posing a safety hazard to residents.
Deficiencies (3)
| Description |
|---|
| Failed to maintain a clear and unobstructed access path to one designated exit discharge door on the Memory Impaired unit, blocked by two 3'-6" square tables. |
| Failed to maintain a clear and unobstructed exit discharge door in stairwell One, which could only be opened 3 inches due to snow build-up outside. |
| Failed to maintain a clear egress path to a public way at stairwell Two exit discharge door, blocked by approximately seven inches of snow. |
Report Facts
Census: 95
Sample Size: 5
Number of blocked exit discharge doors: 4
Snow blockage height: 7
Snow blockage height: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Building Services Director | Interviewed during the inspection regarding blocked exit doors and snow removal. | |
| Administrator | Requested to provide facility layout during the survey entrance. |
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