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 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: 70
Capacity: 82
Deficiencies: 11
May 17, 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 professional standards of care, discharge documentation, medication administration, respiratory care, pharmacy services, drug regimen review, food safety, staffing ratios, and life safety code compliance including emergency lighting and fire alarm system.
Severity Breakdown
SS=D: 6
SS=E: 1
SS=F: 4
Deficiencies (11)
| Description | Severity |
|---|---|
| Failed to ensure physician's order and documentation for discharge and diet order were followed. | SS=D |
| Failed to document a discharge summary including recapitulation of stay and final resident status. | SS=D |
| Failed to maintain necessary respiratory care and suctioning services according to standards for three residents. | SS=E |
| Failed to provide pharmaceutical services ensuring expired medications removed, proper labeling, and accurate inventory. | SS=D |
| Failed to follow up and act upon consultant pharmacist recommendations and identify medication irregularities. | SS=D |
| Failed to properly label and date opened bulk dry food items and maintain sanitary kitchen environment. | SS=D |
| Failed to maintain required minimum direct care staff to resident ratios on one day shift. | — |
| Failed to provide emergency lighting at emergency generator transfer switches. | SS=F |
| Failed to locate manual fire alarm box within 60 inches of rear exit door. | SS=F |
| Failed to inspect fire doors annually by qualified individual with documentation. | SS=F |
| Failed to complete three-year load bank test on emergency generators. | SS=F |
Report Facts
Census: 70
Total Capacity: 82
Deficient CNA staffing: 1
Expired medication count: 2
Medication cart unlabeled items: 3
Medication cart unlabeled tablets: 23
Milk crates: 6
Bulk sugar and flour bags: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse #1 | Interviewed regarding discharge process and medication administration | |
| Director of Nursing (DON) | Interviewed regarding discharge orders, medication administration, and pharmacy issues | |
| Licensed Nursing Home Administrator (LNHA) | Interviewed regarding discharge documentation and pharmacy follow-up | |
| Staff Development Coordinator | Conducted re-inservices on medication administration and respiratory care | |
| General Manager/Food Service | Interviewed regarding kitchen sanitation and food storage | |
| Maintenance Director | Confirmed emergency lighting and fire door inspection deficiencies | |
| Consultant Pharmacist | Interviewed regarding medication regimen review and irregularities |
Inspection Report
Routine
Census: 62
Deficiencies: 0
Jul 7, 2022
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the New Jersey Department of Health to assess compliance with CMS and CDC recommended practices for COVID-19.
Findings
The facility was found to be in compliance with 42 CFR §483.80 infection control regulations related to COVID-19 practices.
Report Facts
Sample size: 5
Inspection Report
Complaint Investigation
Census: 89
Deficiencies: 3
Jun 18, 2021
Visit Reason
The inspection was conducted as a complaint survey based on allegations of abuse, neglect, and failure to report and investigate injuries of unknown origin involving Resident #1.
Findings
The facility failed to report an injury of unknown source to the state agency and failed to investigate the injury properly for Resident #1. Additionally, the facility failed to ensure timely emergency medical services were requested when Resident #1 exhibited symptoms of a medical emergency. Corrective actions included staff terminations, policy revisions, staff re-education, and implementation of new reporting and investigation forms.
Complaint Details
Complaint Intake NJ135858 and NJ144937 involved allegations that the facility failed to report and investigate an injury of unknown origin and failed to provide timely emergency care to Resident #1. The complaint was substantiated based on record review, interviews, and policy review.
Severity Breakdown
SS=D: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Failure to report an injury of unknown source to the state agency within required timeframes. | SS=D |
| Failure to investigate an injury of unknown origin thoroughly and prevent further potential abuse or neglect. | SS=D |
| Failure to ensure nursing staff requested emergency medical services timely when Resident #1 exhibited symptoms of a medical emergency. | SS=D |
Report Facts
Census: 89
Sample Size: 5
Deficiencies cited: 3
Date of survey completed: Jun 18, 2021
Date of plan of correction completion: Jul 13, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Registered Nurse #2 | Nurse | Terminated due to error in nursing judgment regarding timing and urgency of calling 911 for Resident #1. |
| Director of Nursing | Director of Nursing | Reviewed Resident #1's medical record and verified failure to report and investigate injury; involved in corrective action implementation. |
| Nursing Home Administrator | Administrator | New administrator hired July 2020; previous administrator responsible for failure to report injury no longer employed. |
Inspection Report
Annual Inspection
Census: 63
Deficiencies: 0
Apr 23, 2021
Visit Reason
The visit was a standard annual survey to assess compliance with 42 CFR Part 483, Subpart B, for Long Term Care Facilities.
Findings
The facility was found to be in substantial compliance with the regulatory requirements for long term care facilities.
Report Facts
Sample size: 18
Inspection Report
Abbreviated Survey
Census: 55
Deficiencies: 0
Dec 3, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the New Jersey Department of Health to assess compliance with infection control regulations and recommended COVID-19 practices.
Findings
The facility was found to be in compliance with 42 CFR §483.80 infection control regulations and has implemented the CMS and CDC recommended practices for COVID-19.
Report Facts
Sample size: 3
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