Inspection Reports for Peace Care St. Ann‘s
198 Old Bergen Rd #2622, Jersey City, NJ 07305, United States, NJ, 07305
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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 details 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 | NJDHSS Privacy Officer named as contact for privacy practices |
Inspection Report
Annual Inspection
Census: 106
Capacity: 120
Deficiencies: 8
Oct 17, 2024
Visit Reason
A Recertification and Complaint Survey was conducted by Healthcare Management Solutions, LLC on behalf of New Jersey Department of Health (NJDOH) from 10/14/24 through 10/17/24.
Findings
The facility was found not in substantial compliance with 42 CFR Part 483, Subpart B, for long term care facilities based on the recertification and complaint visit. Deficiencies were identified in resident rights, accuracy of assessments, nutrition/hydration status maintenance, infection prevention and control, staffing ratios, exit signage, electrical systems maintenance and testing.
Complaint Details
The survey included complaint investigations for complaint numbers NJ00161058 and NJ00177453. The facility was found not in substantial compliance based on these complaints.
Severity Breakdown
SS=D: 4
SS=F: 3
Deficiencies (8)
| Description | Severity |
|---|---|
| Failure to ensure resident dignity and rights, including interference and coercion. | SS=D |
| Failure to accurately code Minimum Data Set (MDS) assessments for residents. | SS=D |
| Failure to maintain acceptable nutritional parameters for residents, including monitoring, assessment, and interventions. | SS=D |
| Failure to establish and maintain an infection prevention and control program, including cleaning and disinfecting patient equipment and hand hygiene during medication administration. | SS=D |
| Failure to maintain required minimum direct care staff-to-resident ratios as mandated by the state of New Jersey. | — |
| Failure to provide illuminated exit signage at the courtyard exit door. | SS=F |
| Failure to conduct annual electrical outlet testing in resident areas. | SS=F |
| Failure to conduct required load bank testing on the diesel-powered emergency generator every 36 months. | SS=F |
Report Facts
Survey Census: 106
Total Capacity: 120
Sample Size: 42
Supplemental Residents: 8
Deficient CNA staffing days: 6
Deficient CNA staffing days: 1
Deficient CNA staffing days: 1
Deficient CNA staffing days: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse (LPN) #1 | Named in infection control deficiency related to hand hygiene and cleaning of patient care equipment. | |
| Primary Care Physician (PCP)1 | Interviewed regarding resident R52's medical condition and communication with the facility. | |
| Director of Nursing | Interviewed regarding infection control practices and staffing. | |
| Administrator | Involved in staffing communication and corrective actions. | |
| Director of Facilities | Responsible for exit signage inspections and electrical system maintenance. |
Inspection Report
Routine
Census: 113
Deficiencies: 0
May 17, 2024
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.
Findings
The facility was found to be in compliance with 42 CFR §483.80 infection control regulations and has implemented CMS and CDC recommended practices to prepare for COVID-19.
Report Facts
Sample Size: 9
Inspection Report
Routine
Census: 145
Deficiencies: 0
Dec 13, 2023
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.
Findings
The facility was found to be in compliance with 42 CFR §483.80 infection control regulations and has implemented CMS and CDC recommended practices to prepare for COVID-19.
Report Facts
Sample Size: 7
Inspection Report
Abbreviated Survey
Census: 110
Deficiencies: 0
Sep 11, 2023
Visit Reason
A Focused Infection Control survey was conducted on behalf of the New Jersey Department of Health.
Findings
The facility was found to be in substantial compliance with 42 CFR 483 subpart B.
Report Facts
Sample Size: 5
Inspection Report
Routine
Census: 102
Deficiencies: 7
Nov 22, 2022
Visit Reason
A Recertification Survey was conducted to determine compliance with 42 CFR Part 483, Requirements for Long Term Care Facilities.
Findings
The facility was found to be in substantial compliance with emergency preparedness requirements but had deficiencies related to developing and implementing comprehensive care plans, meeting professional standards for services provided, pharmacy services, staffing, life safety code, and food safety requirements.
Deficiencies (7)
| Description |
|---|
| Failed to develop and implement a comprehensive person-centered care plan for residents. |
| Failed to meet professional standards of quality in services provided, including transcription of physician's orders. |
| Failed to provide pharmaceutical services in accordance with professional standards of practice, including accurate medication administration. |
| Failed to maintain required minimum direct care staff to resident ratios for day shifts. |
| Failed to comply with life safety code requirements including means of egress, illumination, fire alarm system, sprinkler system, fire drills, electrical systems, and emergency lighting. |
| Failed to meet food safety requirements including proper storage, labeling, and temperature control of food items. |
| Failed to submit payroll based journal report to CMS in a timely manner. |
Report Facts
Census: 102
Sample size: 21
Staffing deficiency: 7
Staffing ratios: 11
Staffing ratios required: 12
Staffing ratios: 10
Staffing ratios required: 12
Inspection Report
Complaint Investigation
Census: 103
Deficiencies: 2
Mar 11, 2022
Visit Reason
The inspection was conducted as a complaint visit to determine compliance with 42 CFR part 483, Subpart B for long term care facilities.
Findings
The facility failed to ensure proper labeling of denture cups and documentation of residents' weights as ordered by the physician for 2 of 4 residents reviewed. Nursing staff were counseled and corrective actions including audits and education were implemented.
Complaint Details
The visit was complaint-related and the facility was found not in compliance with labeling denture cups and documenting resident weights as ordered. The nursing staff was counseled and corrective actions were implemented.
Severity Breakdown
SS=B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to label denture cups with resident's name as per facility policy. | SS=B |
| Failure to document weekly weights for residents as ordered by the physician according to facility policy. | SS=B |
Report Facts
Census: 103
Sample Size: 4
Completion Date: Mar 31, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Director of Nursing | Named in relation to responsibility for ensuring denture cup labeling and weight documentation |
| Resident Care Coordinator | Resident Care Coordinator | Named in relation to responsibility for ensuring denture cup labeling and weight documentation |
| Certified Nursing Assistant | Mentioned as responsible for labeling denture cups |
Inspection Report
Complaint Investigation
Census: 101
Deficiencies: 0
Nov 26, 2021
Visit Reason
The inspection was conducted based on a complaint visit to assess compliance with 42 CFR part 483, Subpart B for long term care facilities.
Findings
The facility was found to be in compliance with the regulatory requirements based on this complaint visit.
Complaint Details
The visit was complaint-related and the facility was found compliant; no deficiencies were cited.
Report Facts
Sample Size: 3
Inspection Report
Abbreviated Survey
Census: 78
Deficiencies: 0
Nov 16, 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.
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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