Aristacare at Norwood Terrace

Inspectors wroteBased on interview and record review, it was determined that the facility failed to develop and implement a care plan that meets the medical needs identified on the comprehensive assessment care for 1 of 20 residents reviewed for comprehensive care plans. (Resident #94). This deficient practice was evidenced by the following: A review of Resident # 94's admissions record revealed that, Resident # 94 was admitted with but not limited to Heart Failure, Asthma (a long-term inflammatory disease in the lungs), and Acute Pulmonary Edema (a buildup of fluid in the lungs), A review of Resident #94's admission Minimum Data Set (MDS) dated [DATE] revealed under section O that the resident received continues oxygen. [...]

Inspectors wroteCompliant #NJ00175438 Based on observation, interview, and pertinent facility documentation, it was determined that the facility failed to ensure that incontinence care was provided to a dependent resident in a timely manner. This deficient practice was identified for 1 of 20 residents (Resident #73) during incontinence care observations on 1 of the 2 units (2nd and 3rd Floors). This deficient practice was evidenced by the following: On 03/27/2025 at 10:14 AM, during the initial tour of the facility, the surveyors noted a strong odor of fecal matter and urine in the hallway on the third floor, immediately upon exiting the elevators. On 03/27/2025 at 10:15 AM, the surveyor observed Resident #73 sitting on the bed in his/her bedroom with his/her pants down, exposing a brown stained and torn incontinent brief. [...]

Inspectors wroteBased on observation, interview, record review, and pertinent facility documents it was determined that the facility failed to provide appropriate and sufficient treatment and care based upon current standards of practice specifically by allowing a catheter drainage bag to be in contact with the floor. The deficient practice was identified for 1 of 1 resident (Resident # 7) reviewed for Urinary Catheter or Urinary Tract Infection. On 3/27/2025 at 10:59 AM during the initial tour, the surveyor observed Resident # 7 in bed. At that time, the surveyor observed a catheter drainage bag covered by a privacy bag secured to the bed frame but in contact with the floor below. On 3/28/2025 at 10:50 AM, the surveyor observed Resident # 7 in bed. At that time, the surveyor observed a catheter drainage bag covered by a privacy bag secured to the bed frame but in contact with the floor below. [...]

Inspectors wroteBased on observation, interview, review of medical records, and review of other facility documentation, it was determined that the facility failed to implement infection control measures for the handling and storage of respiratory equipment for 1 of 2 residents reviewed for respiratory care (Residents #94). This deficient practice was evidenced by the following: On 03/28/2025 at 11:41 AM, during rounds the surveyor observed Resident #94 sitting in bed in his/her room with the nasal cannula (a tube used to deliver oxygen through the nose) rolled up exposed to the air on top of the oxygen concentrator (a medical device that delivers extra oxygen to the patient). The oxygen concentrator was turned on. On 04/01/2025 at 10:46 AM during rounds the surveyor observed Resident # 94's nasal cannula rolled up and exposed to air on the top of the oxygen concentrator. [...]

Inspectors wroteBased on observation, interview and review of facility documentation, it was determined that the facility failed to a.) properly handle and store potentially hazardous foods in a manner that is intended to prevent the spread of food borne illnesses and b.) maintain equipment and kitchen areas in a manner to prevent microbial growth and cross contamination. This deficient practice was evidenced by the following: On 01/23/2023 at 9:54 AM, the surveyor toured the kitchen, in the presence of the Director of Dietary (DOD) and observed the following: In the food preparation area, there were 4 cartons of milk and 6 dessert cups that were sitting on the table, unlabeled, and not refrigerated or being kept cold on ice. The DOD stated the items were left over from breakfast and confirmed the milk and dessert cups should have been labeled and refrigerated. [...]

Inspectors wroteBased on observation, interview, and review of facility documentation, it was determined that the facility failed to accurately assess two residents' status in the Minimum Data Set (MDS), an assessment tool used to evaluate resident's care needs. This deficient practice was observed for 2 of 22 residents reviewed, Resident #21 and #31 and was evidenced by the following: 1. Review of the admission Record indicated that Resident #31 was admitted to the facility on 4/2013. Review of the most recent quarterly MDS dated [DATE] indicated that Resident #31 had a Brief Interview of Mental Status of 3, meaning the resident had severe cognitive impairment. Medical Diagnosis for Resident #31 included, but not limited to dementia, urinary calculus (kidney stones), dysphasia (difficulty swallowing), hypothyroidism (slow thyroid function), and hypertension (high blood pressure). [...]

Inspectors wroteBased on observation, interview, and record review it was determined the facility failed to maintain profession standards of clinical practice for 2 of 22 residents (Resident #8 and #66) reviewed by a.) documenting on the Treatment Administration Record (TAR) that preventative heel boots were applied to a resident when they were not and not following the physicians most recent order for heel boots and b.) correctly transcribe an order to the Medication Administration Record (MAR) to remove a medication patch. This deficient practice was evidenced by the following: a.) On 01/23/23 at 10:53 AM, during the initial tour of the facility Resident #8 was observed in bed. The surveyor observed that there were foot boots on the resident's nightstand. Resident #8 told the surveyor they get put on at night. The surveyor asked the resident if he/she could move legs and the resident said, not at all. [...]

Inspectors wroteBased on observation, interview, and review of facility documentation it was determined that the facility failed to obtain physician orders for urinary catheter care for Resident #31, 1 of 2 resident reviewed for urinary catheters and was evidenced by the following: On 01/23/23 at 10:40 AM, during the initial tour of the facility Resident #31 was in the bed. The surveyor observed a urinary catheter tubing with dark yellow urine hanging at the bedside. The urinary collection bag was in a privacy bag. Review of the admission Record indicated that Resident #31 was admitted to the facility on 4/2013. Review of the most recent quarterly Minimum Data Set (MDS), an assessment tool dated 12/26/22 indicated that Resident #31 had a Brief Interview of Mental Status of 3, meaning the resident had severe cognitive impairment. [...]

Inspectors wroteBased on observation, interview, review of the medical record and other facility documentation, it was determined that the facility failed to obtain a physician order for the use of oxygen for 1 of 1 residents reviewed for oxygen, (Resident #19). This deficient practice was evidenced by the following: During the initial tour of the facility on 01/23/23 at 10:40 AM the surveyor observed Resident # 19 in bed receiving Oxygen via nasal cannula (a device used to deliver supplemental oxygen). On 01/24/23 at 11:48 AM and on 01/26/23 10:41 AM the surveyor observed Resident #19 receiving Oxygen via nasal cannula. According to the admission Record, Resident #19 was admitted to the facility with diagnosis of Chronic Obstructive Pulmonary Disease (COPD). The surveyor reviewed the Clinical Physician Orders for Resident #19 and did not observe an order for Oxygen. [...]

Inspectors wroteBased on observation, interview and record review, it was determined that the facility failed to: a.) remove controlled drugs (Valium, Ativan bottle #1 and Ativan bottle #2) from active inventory stored in the refrigerator in a timely manner when the controlled drugs were discontinued on 5/1/2020, 12/31/20 and 2/18/21 respectively, b.) perform accountability and reconciliation for controlled drugs (Valium and Ativan bottle #1) and c.) remove a controlled drug (Ativan bottle #2) that had expired on 1/18/21. This deficient practice was identified for 1 of 2 refrigerated medication storage units reviewed and was evidenced by the following: On 3/31/21 at 11:02 AM, two surveyors reviewed the medications stored in the refrigerator on the nursing unit with the Licensed Practical Nurse (LPN) At that time, the surveyors observed in the refrigerated locked box three (3) controlled drugs: [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to ensure that all medications were administered without an error rate of 5% or more. During the medication pass on 3/31/21, the surveyor observed two (2) nurses administer medications to six (6) residents. There were 34 opportunities and two (2) errors observed which calculated to a medication administration error rate of 5.8%. This deficient practice was identified for 2 of 2 nurses administering medication to 2 of 6 residents, (Resident #25 and #73). The evidence was as follows: 1. On 3/31/21 at 8:43 AM, the surveyor conducted the medication pass in the presence of a second surveyor. [...]

Inspectors wroteBased on observation, interview, record review, and review of pertinent facility documentation, it was determined that the facility failed to ensure: a.) a long-acting scheduled dose of an antipsychotic medication (Haldol) was administered every 28 days in accordance with a resident's psychiatric plan of care, and b.) a comprehensive care plan was in place to address the resident's antipsychotic medication (Haldol). This deficient practice was identified for 1 of 5 residents reviewed for unnecessary medications (Resident #227). The evidence was as follows: On 3/31/21 at 8:25 AM, the surveyor observed Resident #227 seated on the edge of the bed in his/her room. The resident appeared comfortable and was well-groomed. [...]