Inspection Reports for Preferred Care at Old Bridge

Complaint NJ# 420827 and 2636492. The complaint investigation found substantiated deficiencies related to call bell accessibility and inadequate assistance with activities of daily living including toileting and hygiene.

The facility failed to ensure residents' call bells were within reach and could be activated, and residents' needs were not met timely after call bell activation for 3 of 9 residents. Additionally, the facility failed to provide appropriate assistance with toileting and personal hygiene care for 4 of 6 residents, evidenced by soiled linens, unmet shower schedules, and delayed incontinence care.

The investigation was complaint-driven based on complaints NJ187513 and NJ187972. The complaints were substantiated as the facility failed to develop required care plans and failed to prevent elopement incidents.

The facility failed to develop an elopement risk care plan for Resident #5 despite identification as an elopement risk, and failed to adequately supervise Resident #2 who eloped from the facility when a family member held the door open, violating facility policy and safety protocols.

Complaint numbers NJ00174183 and NJ00180900 triggered the survey. The medication administration error deficiency was substantiated based on observation, interview, and record review.

Deficiencies were cited related to medication administration errors, specifically a medication administration error rate of 6.25% involving Resident #79 and three nurses. The facility failed to ensure all medications were administered without error. A plan of correction included re-education and competency training for involved staff. Additional Life Safety Code deficiencies were found related to means of egress, emergency lighting, hazardous areas, sprinkler systems, corridor doors, and electrical equipment maintenance.

The complaint investigation found that the facility failed to ensure medication administration without error of 5% or more. The errors involved insulin administration timing and supply issues for Resident #79. The investigation included observations, interviews with nursing staff, the Director of Nursing, Consultant Pharmacist, and review of medical records and facility policies.

The facility failed to ensure medication error rates were below 5%, with a 6.25% error rate observed during medication administration to five residents. Specifically, errors were identified in the timing and administration of Insulin Lispro and Insulin Glargine for Resident #79, including administering insulin at incorrect times relative to meals and lack of adequate insulin supply.

The facility was found deficient in several areas including failure to timely transmit MDS assessments, failure to develop comprehensive care plans addressing nutritional concerns for multiple residents, failure to provide recommended nutritional supplements, failure to identify and address significant weight loss, failure to ensure physician addressed severe weight loss, and failure to maintain safe and appetizing food temperatures during meal service.

Deficiencies were cited related to timely transmission of Minimum Data Set (MDS) assessments, failure to develop comprehensive care plans for residents with nutritional concerns, failure to maintain acceptable nutritional and hydration status, failure to ensure physician supervision addressing nutritional issues, and failure to maintain safe and appetizing food temperatures. Staffing ratios for Certified Nurse Aides (CNAs) did not meet state minimum requirements on multiple days.

The facility was found noncompliant with fire safety requirements including failure to have self-closing fire-rated doors on hazardous areas, malfunctioning bathroom exhaust systems, non-functional GFCI electrical outlets near water sources, lack of annual electrical receptacle testing, and absence of a remote emergency stop button for the emergency generator.

The complaint investigation involved multiple complaint numbers alleging abuse, neglect, exploitation, or mistreatment, including racial verbiage used by a housekeeper and injuries of unknown origin to a resident. The facility investigated and found no evidence to support the allegations but failed to report the results to the NJDOH as required.

The facility failed to report the results of all alleged violation investigations to the New Jersey Department of Health within prescribed timeframes. The investigation found no evidence to corroborate the allegations of racial verbiage by a housekeeper or unknown origin injuries to a resident, but the facility did not report the allegations to the state agency as required.

The facility failed to meet required staffing ratios for 5 of 14 shifts reviewed, potentially affecting all residents. The facility has implemented corrective actions including increased staffing rates, advertising, job fairs, agency contracts, and ongoing monitoring by the Director of Nursing.

The facility failed to ensure proper administration of Midodrine according to physician's hold parameters, accurate documentation and pre-medication for pain management, appropriate use and documentation of restorative nursing interventions including multipodus boots and positioning wedges, and proper destruction and documentation of controlled medications. Multiple medication errors were identified over several months despite education and quality assurance efforts.

Deficiencies were cited related to medication administration not following physician hold parameters, inaccurate documentation of skin condition, failure to implement restorative nursing programs as per physical therapy recommendations, inadequate pain management including delayed administration of breakthrough medication, and improper destruction and documentation of controlled medications.