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 explains the types of information covered, reasons for use and disclosure of health information, individuals' rights regarding their health 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
Complaint Investigation
Census: 71
Deficiencies: 0
Feb 8, 2024
Visit Reason
The inspection was conducted as a complaint investigation related to complaint NJ00165624.
Findings
The facility was found to be in substantial compliance with New Jersey standards for licensure of assisted living residences and related programs for this complaint investigation.
Complaint Details
Complaint NJ00165624 was investigated and the facility was found to be in substantial compliance.
Report Facts
Sample size: 5
Inspection Report
Routine
Census: 70
Deficiencies: 0
Dec 18, 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: 60
Deficiencies: 3
May 13, 2022
Visit Reason
The inspection was conducted as a complaint investigation and COVID-19 focused infection control survey based on complaints NJ00153715 and NJ00154709.
Findings
The facility was found not in substantial compliance with New Jersey Administrative Code 8:36 standards for licensure of assisted living residences. Deficiencies included inaccurate medication administration documentation for one resident and failure to maintain proper controlled substance inventory records and shift-to-shift narcotic counts.
Complaint Details
Complaint investigation based on complaints NJ00153715 and NJ00154709. The facility was found deficient in medication administration documentation and controlled substance inventory accountability.
Deficiencies (3)
| Description |
|---|
| Failure to ensure medication was accurately documented as administered in accordance with prescriber's orders for Resident #4, including administration of lorazepam doses less than eight hours apart. |
| Failure to ensure controlled substance medications were documented as administered on the Medication Administration Record after removal from inventory for Resident #4. |
| Failure to ensure consistent documentation of shift-to-shift narcotic counts to maintain accountability of controlled substance inventory. |
Report Facts
Census: 60
Sample Size: 5
Dates with missing narcotic count signatures: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse (LPN) | Interviewed regarding medication documentation and controlled substance inventory discrepancies; unable to recall specific events. | |
| Health and Wellness Director (HWD) | Interviewed regarding medication orders and dosing intervals for Resident #4. |
Inspection Report
Routine
Census: 55
Capacity: 79
Deficiencies: 3
Nov 17, 2021
Visit Reason
Standard survey of 79 residential units to assess compliance with New Jersey Administrative Code 8:36 for licensure of assisted living residences and related programs.
Findings
The facility was found not in substantial compliance with all standards, with deficiencies noted in employee physical examination records, resident advance directive policies, and employee tuberculosis testing upon hire.
Deficiencies (3)
| Description |
|---|
| Failure to ensure employee files included records of physical examinations for one of five employees reviewed, specifically Customer Service Representative (CSR) #1. |
| Failure to ensure residents were provided information on executing advance directives, affecting two of six residents reviewed (Resident #3 and Resident #6). |
| Failure to ensure each new employee received Mantoux tuberculin skin testing upon hire for one of five employees reviewed, specifically CSR #1. |
Report Facts
Census: 55
Total licensed capacity: 79
Sample size: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Customer Service Representative #1 | Named in findings related to missing physical examination and tuberculosis testing records. | |
| Executive Director | Interviewed regarding missing employee physical and tuberculosis testing records. | |
| Business Office Manager | Interviewed regarding missing resident advance directive information. | |
| Infection Preventionist | Interviewed regarding missing Physician's Order for Life Sustaining Treatment (POLST) documentation. |
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