Inspection Reports for The Palace Rehabilitation and Care Center

Complaint #: NJ 185087. The complaint was substantiated as the facility had hot water temperatures exceeding safe limits, posing immediate jeopardy to residents.

The facility failed to maintain hot water temperatures at a safe level, with readings between 137.1°F and 138.4°F on the C-Wing nursing unit, exceeding the recommended 95-110°F range. This created an Immediate Jeopardy situation due to the risk of serious injury from scalding burns. The facility implemented a removal plan to lower water temperatures and monitor residents for skin damage.

The facility was found deficient in multiple areas including failure to revise a resident's care plan after smoking policy violations, inadequate supervision during resident smoking sessions, incomplete dialysis communication documentation, medication administration errors, improper food storage and labeling, failure to maintain kitchen equipment sanitation, inadequate infection control practices related to PPE use during wound care, and unsafe physical environment conditions in the central supply room.

Complaint #: NJ172102. The complaint involved alleged misappropriation of resident property and concerns about unnecessary medications. The investigation found the facility failed to report the alleged violation to the NJDOH and failed to thoroughly investigate the allegation. The complaint was unsubstantiated for drug diversion but identified deficiencies in reporting and investigation.

The facility failed to report an alleged violation of misappropriation of resident property to the New Jersey Department of Health and failed to thoroughly investigate the allegation. Additionally, the facility did not maintain accurate and complete medical records for two residents regarding pain medication administration, with multiple instances of missing pain level documentation and medication administration signatures. The facility also failed to ensure a safe and sanitary physical environment in the central supply room.

The survey included investigations of multiple complaints (NJ164832, 165602, 167382, 168691, 168917, 172102, 175383, 175570, 175710, 175725, 175728, 176593, 176873). Some allegations were substantiated, including failure to report and investigate abuse and misappropriation, medication errors, and unsafe environment issues.

The facility was found to be noncompliant with multiple regulatory requirements including failure to report alleged violations, inadequate medication administration documentation, deficient care plan revisions, unsafe physical environment conditions, and infection control deficiencies. Corrective actions and systemic changes were required.

Complaint #: NJ00175122. The facility failed to meet minimum staffing requirements for certified nursing assistants on 9 of 14 day shifts prior to the survey. No residents were affected by this negative outcome. The facility identified all residents as potentially at risk and implemented systemic changes including recruitment efforts, expedited onboarding, additional staffing agencies, weekly staffing meetings, and quality assurance audits.

The facility was found to be in substantial compliance with federal requirements but failed to meet New Jersey staffing ratio standards for certified nursing assistants on 9 of 14 day shifts reviewed, potentially affecting all residents.

The complaint investigation included allegations of resident rights violations, missing clothing, inadequate response to resident council concerns, unsafe and unsanitary environment, failure to investigate and report falls with injury, inadequate nutrition and dietitian services, infection control breaches, and lack of quality assurance oversight.

The facility failed to ensure resident rights were respected, including protection of personal belongings and dignity. There were multiple environmental deficiencies including unsafe and unsanitary conditions in resident rooms and common areas. The facility did not properly investigate or report a resident fall with injury, failed to provide adequate nutrition and dietitian services, and did not maintain proper infection control practices. Quality assurance processes were inadequate to address ongoing issues.

Complaint # NJ 00160152 was investigated and found to be substantiated related to resident rights violations and other deficiencies.

The facility was found deficient in multiple areas including resident rights violations, environmental safety and cleanliness, complaint follow-up, nutrition and hydration, infection control, staffing, and life safety code compliance. Deficiencies included failure to protect resident belongings, inadequate response to complaints, poor food quality and temperature control, insufficient staffing, unsafe environment, and incomplete investigations of incidents.

Complaint NJ162163 was substantiated based on interviews, record reviews, and facility policy reviews indicating failure to administer medications as ordered and lack of physician notification.

The facility failed to follow physician's orders and facility policies on medication administration for Resident #2, as evidenced by multiple instances where medications were not administered or documented. The facility's staff did not notify the physician when medications were missed, and documentation was incomplete.

Complaint # NJ162163. The facility was found not in substantial compliance with 42 CFR Part 483, Subpart B, based on this complaint visit.

The facility failed to follow a physician's order and facility policies on medication administration for one resident, as evidenced by undocumented medication administration and lack of physician notification. Licensed nursing staff did not document medication administration properly, and the facility was found not in substantial compliance with professional standards.

The facility was found to be in noncompliance with several Life Safety Code requirements including insufficient number of exits on a floor, non-functioning emergency lighting, penetrations in fire barriers, improperly installed fire extinguishers, smoke barrier doors with excessive gaps, inadequate bathroom ventilation, malfunctioning laundry chute door, and lack of GFCI protection on electrical outlets near water sources.

The survey identified multiple deficiencies including failure to ensure accessibility of survey results to residents, failure to provide required Medicaid/Medicare notices, medication administration and transcription errors, incomplete neurological assessments after falls, failure to notify physician of significant weight loss, improper medication storage, breaches in infection control protocols including PPE use and hand hygiene, and failure to conduct required COVID-19 testing for staff not up-to-date on vaccinations.

Complaint Intake #NJ151090, NJ150740, NJ149627, NJ149574. The survey was triggered by multiple complaints alleging failures in notification, infection control, environment, medication administration, pressure ulcer care, incontinent care, and medical record keeping.

The facility was found non-compliant with several regulatory requirements including failure to notify resident representatives of changes in condition, inadequate environmental cleanliness and maintenance, failure to provide prescribed pain medication timely, inadequate treatment and documentation of pressure ulcers, improper incontinent care, unsecured suprapubic catheters, and incomplete medical record documentation.

The facility failed to ensure that the building was inspected by a local fire code official on a quarterly basis for the last five quarters, with only one inspection documented during that period. This was due to a change in local fire inspection staffing, which the facility could not document. The deficiency was communicated to the Administrator during the Life Safety Code survey exit conference.

The facility was found noncompliant with several life safety code requirements including egress door operation, number of exits per floor, illumination of means of egress, sprinkler system maintenance, smoke barrier door functionality, and electrical equipment wiring. Multiple deficiencies were identified related to door locking mechanisms, exit access, lighting, sprinkler escutcheon plates and ceiling integrity, smoke barrier door closure, and unsafe use of extension cords.

Complaint #NJ142500 was substantiated. The complaint involved a physical assault by Resident #2 on Resident #3, with Resident #2 refusing medications and not being properly evaluated or supervised as required.

The facility was found not in substantial compliance with 42 CFR Part 483, Subpart B, due to failure to ensure a safe environment and adequate supervision for residents with behavioral issues. Resident #2 physically assaulted Resident #3, resulting in hospitalization. Resident #2 refused medications controlling behaviors and was not monitored or evaluated timely as required by PASRR Level II. The facility failed to follow its own policies on safety and supervision, and corrective actions were implemented including staff education and increased monitoring.