Alliance Care Rehabilitation and Nursing Center

Inspectors wroteBased on record review, interview, and policy review, the facility failed to ensure an allegation involving an injury of unknown origin was reported as required for one out of one sampled resident (Resident (R)12) reviewed for reporting requirements. Specifically, R12 was discovered on 06/14/26 with an unwitnessed head injury after being observed attempting to climb back into bed. The facility's failure to report an injury of unknown origin had the potential to delay regulatory review and intervention, which could allow abuse, neglect, mistreatment, or exploitation to go unidentified and unaddressed, placing residents at risk for further harm.

Inspectors wroteBased on observation, interview, record review, and policy review, the facility failed to ensure a medication error rate of less than five percent. A total of two errors occurred out of 25 opportunities for a medication error rate of 8%. This error affected one of six residents (Resident (R) 141) who were observed for medication administration.

Inspectors wroteBased on record review, interview, and policy review, the facility failed to provide three of three residents (Residents (R)77, R268 and R54) a Centers for Medicare and Medicaid Services (CMS) for Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN) when they completed their Medicare A therapy services. This failure to provide the CMS for SNF ABN prevented the resident from knowing they had days remaining under Medicare A.

Inspectors wroteBased upon record review, interviews, and review of facility policy, the facility failed to prevent resident-to-resident abuse on 03/24/23 when Resident (R)54 pushed and hit R411 in the back. This deficiency has the potential to facilitate future resident-to-resident physical altercations resulting in serious injury or serious physical or psychosocial impairment.

Inspectors wroteNJAC 8:39-9.4(f) Based on interview, record review, and facility policy review, the facility failed to thoroughly investigate resident-to-resident abuse incidents for three residents (Residents (R)54, R210, and R411) reviewed for abuse out of a sample size of 31. This failure has the potential for further resident-to-resident abuse occurring and not being investigated so interventions can be put in place.

Inspectors wroteBased on observation, record review, interview, and facility policy review, the facility failed to ensure a resident was appropriately positioned with head elevated while receiving nutrition through a feeding tube for one of one resident (Resident (R) 91) reviewed for tube feeding out of a sample of 31 residents. The lack of head elevation could result in aspiration.

Inspectors wroteBased on observation, record review, interview, and facility policy review, the facility failed to have medications available to administer as ordered, document why the medications were not given, and maintain accessible records for a controlled medication for three of seven residents (Resident (R) 141, R261, and R366) reviewed for medication administration or pain. This had the potential to result in adverse health outcomes.

Inspectors wroteBased on observation, record review, interview, and facility policy review, the facility failed to ensure a medication error rate of less than five percent during observation of medication administration. The facility had three errors in twenty-five opportunities, which resulted in a 12 percent error rate. This affected one (Resident (R) 366) out of four residents observed. Medication errors have the potential to result in adverse health outcomes. Refer to F755.

Inspectors wroteBased on observation, record review, interview, and policy review, the facility failed to utilize the proper personal protective equipment (PPE) for enhanced barrier precautions (EBP) and failed to perform proper hand hygiene for one of five residents (Resident (R) 91) reviewed for EBP out of a sample of 31 residents. This created a potential for the transmission of infection to staff and other residents.

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to ensure: a.) there was no delay in implementing recommendations made by the consulting wound care Nurse Practitioner (NP), b.) care planned interventions to promote wound healing were implemented for a resident who was identified at risk for developing a pressure ulcer (PU) and developed a Stage 2 sacral PU, and c.) a thorough assessment for (PU) risk factors was completed. This deficient practice was identified for 1 of 5 residents reviewed (Resident #49) for PU, who developed a new PU on 10/27/22, and was evidenced by the following: On 11/07/22 at 10:15 AM, the surveyor toured the 300's Unit of the facility and observed Resident #49 in bed with the head of the bed elevated, facing the door, the feet rested on the mattress, and the eyes were closed. [...]

Inspectors wroteBased on observation, interview, and document review, it was determined that the facility failed to maintain the kitchen, and pantry areas, in a clean and sanitary manner to limit the spread of infection and potential food borne illness by failing to ensure: a.) the environment and kitchen equipment was maintained in a manner to limit the potential for microbial growth, b.) the dish machine was operated within appropriate temperature specifications per the policy, c.) the chlorine test strips were used per manufacturer's directions, and d.) resident food stored in unit refrigerators was labeled and dated. The deficient practice occurred was observed in the main kitchen, and in the second, third and fourth floor resident pantry, and was evidenced by the following: Reference: U.S. [...]

Inspectors wroteBased on interview and review of facility documentation, it was determined that the facility failed to ensure that facility wide assessment included the resources required to establish policies and procedures for management of on-going outbreak of Candida Auris (C. Auris, an emerging fungus that presents a serious global health threat) which dated back to October 2020 on the Ventilator Unit. This deficient practice was identified by the following. Reference F880, F882 On 11/07/22 at 10:53 AM, during entrance conference, the facility Licensed Nursing Home Administrator (LNHA) informed the survey team that the facility was currently in an outbreak of C. Auris. The survey team was informed that there were currently nine cases in the facility and the residents resided on the first floor ventilator unit. [...]

Inspectors wroteSurveyor B 4. On 11/10/22 at 11:39 AM, the surveyor observed a staff member (who was later identified as a Licensed Practical Nurse Apprentice (LPNA)) wearing an N95 mask, glasses (not protective goggles or face shield) and gloves, deliver a lunch tray to Resident #92. She placed the lunch tray on the bed side table and moved the table over to the side of the resident's bed. The LPNA removed her gloves and exited the room. She then used hand sanitizer donned a gown and gloves and went back into room and assisted the resident with his/her meal. The surveyor observed signage on the outside of the resident's room: a STOP, Must See Nurse sign, a Droplet Precautions Everyone Must: .Make sure their eyes, nose and mouth are fully covered before room entry sign, and a Contact Precautions Everyone Must: .Put on gown before room entry. Discard gown before room exit sign. [...]

Inspectors wroteComplaint #NJ00158982 Based on facility staff interviews and review of other pertinent facility documentation, it was determined that the facility failed to ensure that the designated Infection Preventionist (IP) had completed specialized training in infection prevention and control and was qualified by certification and experience for 1 of 1 staff member reviewed in accordance with Center for Medicare and Medicaid Services (CMS) and New Jersey State guidelines. This deficient practice was evidenced by the following: Reference: State of New Jersey Department of Health Executive Directive No 20-026-1 dated October 20, 2020, revealed the following: ii. Required Core Practices for Infection Prevention and Control: [...]

Inspectors wroteBased on observation, staff interviews, and review of pertinent documentation, it was determined that the facility failed to provide a clean, and comfortable homelike environment to residents who resided at the facility. The lack of oversight to ensure equipment, and the environment was clean created a potential environmental hazard to the residents who resided at the facility. The deficient practice was observed in 10 rooms on 1 of 4 Resident units, and was evidenced by the following: On 11/07/22 from 10:10 AM to 11:47 AM, the surveyor conducted a tour of the 300's Unit low side and observed the following: The heating/cooling units in Rooms #303, #306, #310, #340, #344 revealed that all the heating and cooling units were covered with various bed linen, and the metal bases were covered with a rust like substance. [...]

Inspectors wroteBased on observation, interview, record review, and review of pertinent documents, it was determined that the facility failed to a.) apply physician ordered interventions that the staff signed as administered for Resident #105, 1 of 4 residents reviewed for wound treatments, and b.) administer medication with food as prescribed by the physician and improperly dispose of non-administered medication, for Resident #105 and an unsampled resident during medication administration observation. The evidence was as follows. a.) On 11/15/22 at 9:04 AM, Surveyor #2 observed Resident #105 lying in bed on his/her left side with both feet in direct contact with the bed. Surveyor #2 observed there were no heel protectors on the resident and no offloading of the resident's heels. A review of Resident #105's medical records revealed the following: [...]

Inspectors wroteBased on observation, interview, record review, and review of pertinent documents, it was determined that the facility failed to provide appropriate care for resident's who were dependent on staff to provide Activity of Daily Living (ADL) care. This deficient practice occurred for 4 of 4 dependent residents (Resident #49, #34 and #101 and #114) and on two of four resident care units (3rd and 4th floor) reviewed for ADL care and was evidenced by the following: 1. On 11/07/22 at 10:15 AM, the surveyor toured the 300's Unit of the facility and observed Resident #49 in bed with the head of the bed elevated, and was facing the door, and both feet rested directly on the mattress, and eyes were closed. The fingernails were observed as long and jagged, and contained a black coated substance underneath all of the fingernails. The upper lip and chin were covered with facial hair. [...]

Inspectors wroteBased on observation, interview, record review and review of other pertinent facility documents, it was determined that the facility failed to: a.) ensure that medications were administered in accordance with the physician order for 6 residents reviewed (Resident #3, #14, #24, #42, #92, #102) for two days (11/15/22 and 11/16/22), and b.) implement physician ordered interventions for 1 of 1 resident (Resident #105) reviewed for skin concerns. This deficient practice was evidenced by the following: a.) Surveyor #1 conducted a medication Pass Observation on 11/16/22 on the 300's Unit of the facility and observed that some of the medications were not available for administration. Resident #3 had diagnoses of essential hypertension and edema. Resident #3 had an order for Lasix (a loop diuretic) to be administered daily for edema. [...]

Inspectors wroteBased on observation, interview, record review and review of pertinent documentation, it was determined that the facility failed to: a.) ensure interventions to prevent falls were in place per a resident care plan, b.) complete a fall risk assessment post fall per facility policy, and c.) determine the causal factor after each resident fall and implement appropriate interventions to prevent recurrence. This deficient practice was identified for 1 of 1 resident (Resident #119) reviewed for falls, had experienced four falls, and was evidenced by the following: On 11/07/22 at 11:35 AM, the surveyor observed Resident #119 in the room, sitting in a wheelchair. The resident was alert, and unable to communicate with the surveyor due to a language barrier. A nurse informed the surveyor that there were staff that were able to communicate in Resident #119's native language. [...]

Inspectors wroteBased on observation, interview, record review, and review of pertinent documentation, it was determined that the facility failed to provide sufficient nursing staff to ensure a.) resident with a gradual weight loss, who was at risk for pressure ulcers with an actual stage 2 pressure ulcer, was identified and interventions put in place to prevent worsening (Resident #49), b.) complete fall risk assessment was done post fall to identify causal factors and put interventions in place (Resident #119), c.) appropriate activities of daily living (ADL) care was provided (Resident #49, #34, #101, #114) and d.) a resident's known behaviors were documented and addressed (Resident #19). This deficient practice was evidenced by the following: Refer to: F 686, F 689, F 677, and F 742 a.) Resident #49 was observed on 11/07/22 in bed on his/her back. [...]

Inspectors wroteBased on observation, interview, and medical record review, it was determined that the facility failed to: a.) document target behaviors for residents who are receiving psychotropic medications, b.) implement nonpharmacological interventions, and c.) develop care plan interventions to manage the behaviors of residents who displayed combative and wandering behavior and exhibited difficult to redirect behavior that was unpredictable. This deficient practice was identified for Resident #19, one of 2 residents reviewed for behavior, and was evidenced by the following: During the initial tour on 11/07/22 at 10:37 AM, the surveyor observed a resident entering and exiting other residents' rooms. The resident was identified as Resident #19. On 11/07/22 at 10:40 AM, the surveyor asked the Unit Manager about challenging residents on the unit, she stated there were none. [...]

Inspectors wroteBased on interview and record review, it was determined that the facility failed to provide documentation that the Quality Assurance Performance Improvement (QAPI) committee met at least quarterly. This deficient practice was identified for 2 of 4 meetings for the year 2022, and was evidenced by the following: On 11/07/22 at 10:47 AM during the entrance conference meeting, the Licensed Nursing Home Administrator (LNHA) stated the facility held quarterly QAPI meetings. On 11/14/22 at 10:45 AM, Surveyor #2 interviewed the Infectious Disease Doctor (IDD) via speaker phone (with permission) in the presence of the survey team. The IDD stated that his role has been mainly for education and antibiotic stewardship. The IDD stated that he was not aware that the facility had consistent cases of Candida Auris. The IDD stated, That is a new one. [...]

Inspectors wroteBased on observation it was determined that the facility failed to have call bell system in place for two resident (Resident #114 and #119) and on 1 of 4 Resident units. The deficient practice was evidenced by the following: On 11/07/22 at 11:45 AM, the surveyor interviewed Resident #114 while the resident was in a wheelchair in the room. The surveyor did not observe a call bell located near the resident and the inquired to the resident about the call bell. Resident #114 stated I don't even know if it works, and when they come, they come, and I cannot say on time. On 11/16/22 at 7:59 AM, the surveyor observed Resident #114 awake in bed, and there was no call bell attached to the wall, or by the resident. The Certified Nurse Aide (CNA) assigned to Resident #114 was in the room and the surveyor asked about the call bell for Resident #114, and he stated, it is not there. [...]

Inspectors wroteBased on observations, interviews, and record review, it was determined that the facility failed to ensure that the 24-hour staffing information was posted and displayed in a place that was readily accessible to residents, family members, and the public. This deficient practice was evidenced by the following: The surveyor did not observe the 24-hour staffing information posted in a prominent area that was readily accessible to the public, residents or visitors on 11/9/22, 11/10/22, 11/14/22, 11/15/22, 11/16/22, and 11/18/22. This deficient practice was evidenced by the following: On 11/9/22 at 8:40 AM, 11/10/22 at 8:42 AM, 11/14/22 at 8:45 AM, 11/15/22 at 8:30 AM, and 11/18/22 at 8:33 AM, the surveyor observed the facility's Alliance Staffing Sheet in a clear plastic sleeve at the receptionist desk. [...]