Bergen New Bridge Medical Center

Inspectors wroteComplaint # 2665060 Based on interviews, medical record review, and review of pertinent facility documentation, it was determined on 11/18/25, that the facility failed to ensure the Certified Nursing Assistant (CNA) flow sheets were complete and accurate. this deficient practice was identified for 2 of 3 residents reviewed for resident accuracy (Resident #1, and Resident #2).

Inspectors wroteBased on observation, interview, record review, and policy review, it was determined that the facility failed to; a) sanitize and air-dry steam table pans correctly to prevent microbial growth, b) follow labeling requirements on food products and use-by dates, and c) maintain food and supply storage. This deficient practice was evidenced by the following: On 5/8/25 at 9:45 AM, in the presence of the Operations Managers (OM #1 and # 2) and Executive Administrator (EA), the surveyor observed the following: 1. In the dishwashing area, the surveyor observed 42 steam table pans wet nested as they were stacked with pooling water between them. The surveyor interviewed the Food Service Worker (FSW), who stated, In the morning we stack the pans. The FSW could not explain why there was water between the pans. [...]

Inspectors wroteComplaint NJ # 169798 Based on observation, interview, and review of pertinent facility documentation, it was determined that the facility failed to ensure that the devices used to identify call bell notifications were functioning properly. This deficient practice had the potential to affect all residents residing in Unit 8-7. This deficient practice was evidenced by the following: On 5/12/25 at 1:33 PM, the surveyor upon exit from the elevator, the surveyor observed unit 8-7's call light system machine in the nursing station had a red button on with no audible sounds. There were five staff in the nursing station including the Registered Nurse/Unit Manager (RN/UM). Afterward, the surveyor went to left wing side of Unit 8-7. While the surveyor in the hallway, the surveyor heard one resident yelling for a nurse in Resident room [ROOM NUMBER] (RR#709). [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to inform the resident or their representative in advance of treatment risks and benefits, options, and alternatives to a resident receiving antipsychotic medications. This deficient practice was identified for 1 of 5 residents (Resident #213), reviewed for unnecessary medications. This deficient practice was evidenced by the following: On 5/8/25 at 10:35 AM, the surveyor observed Resident #213 walking in the hallway towards the activity room. On 5/12/25 at 10:00 AM, the surveyor observed the resident in the day/activity room sitting on a chair with other residents, non-verbal, and no behaviors observed. The surveyor reviewed the medical records of Resident #213, and revealed: [...]

Inspectors wroteBased on observation, interview, and review of pertinent facility documentation, it was determined that the facility failed to ensure 3 of 32 residents (Residents #20, #83, and #228) call bells were within reach and able to use to accommodate residents' needs. This deficient practice was evidenced by the following: 1. On 5/8/25 at 1:09 PM, Surveyor #1 (S#1) observed Resident #20 in their room and observed that the call bell was not visible. The resident stated that they did not know where the call bell was located. On 5/12/25 at 10:20 AM, Surveyor #2 (S#2) interviewed Certified Nursing Assistant #1 (CNA#1), who cared for Resident #20, who stated that the resident should have the call bell in reach for use. 2. On 5/8/25 at 12:20 PM, S#1 observed Resident #228 awake and alert in their bed. The surveyor observed that the call bell was not visible. [...]

Inspectors wroteBased on observation and interview it was determined the facility failed to maintain the residents' living environment in a clean, sanitary, and homelike manner for 1 of 32 residents (Resident #132), and 1 unsampled resident (Resident room [ROOM NUMBER]). The deficient practice is evidenced by the following. 1. On 5/8/25 at 11:10 AM, the upon initial tour of the 6th floor, the surveyor observed that inside of Resident room [ROOM NUMBER] (RR#606), there was damage to residents' wall with paint chipped off in five areas, across from the residents' bed. The surveyor also observed damage to the cove base near the residents' closet. The surveyor also observed a 1 inch sized break in the floor tile, also near the resident's closet. 2. On 5/8/25 at 11:16 AM, the surveyor observed that inside Resident #132's room, there were 11 areas of chipped off paint on wall near bathroom. [...]

Inspectors wroteBased on observation, interview, and review of other pertinent facility documents, it was determined that the facility failed to ensure timely revision of the individualized comprehensive care plan and implementation of interventions created by the occupational therapist to stimulate functional performance and prevent further decline. This deficient practice was identified for 1 of 3 residents reviewed for limited range of motion, Resident #25 and was evidenced by the following: On 5/8/25 at 10:30 AM, the surveyor observed the Certified Nursing Assistant (CNA), walking into Resident #25's room, and stated she was there to provide morning care to the resident. On 5/8/25 at 10:36 AM, the surveyor observed the same CNA exited Resident #25 room. The surveyor observed the resident awake, alert, in bed, with closed fist on both hands. The surveyor reviewed the medical record for Resident #25. [...]

Inspectors wroteBased on observation, interview, record review, and review of other pertinent facility documentation, it was determined that the facility failed to ensure the necessary respiratory care and services of residents that were receiving oxygen, according to the standard of clinical practice and facility's policy and procedure, specifically a.) the sterile water bottle utilized for humidification of oxygen was dated for 1 of 8 residents reviewed for respiratory care (Resident #80), and b.) that respiratory equipment were stored in accordance with infection control measures for 1 of 8 residents reviewed for respiratory care (Resident #124). This deficient practice was evidenced by the following: 1. On 5/13/25 at 12:15 PM, the surveyor observed Resident #80 lying in bed with oxygen (O2) being administered at 2 LPM (liters per minute) via nasal cannula (NC) tubing. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed ensure a high blood pressure medication with parameters (defined set of conditions) was administered without significant medication error, the physician's order was followed, adhered to the professional standards of practice and the facility policy of medication administration. The deficient practice was identified for 1 of 4 residents (Resident #81), administered by 1 of 4 nurses observed during the medication administration and was evidenced by the following: On 5/12/25 at 10:06 AM, the surveyor observed Licensed Practical Nurse (LPN) prepare 8 medications (meds) for Resident #81, which included a physician's order (PO) for metoprolol tartrate 25 milligrams (mg) 1 tablet (tab) orally three times a day at 8:00 AM, 2:00 PM (6 hours apart), and 10:00 PM for hypertension (high blood pressure). [...]

Inspectors wroteBased on interview, record review, and review of other facility documentation, it was determined that the facility failed to obtain written consent for the administration of an influenza (flu) vaccine and pneumococcal vaccine for 1 of 5 residents, Resident #213, reviewed for immunizations. This deficient practice was evidenced by the following: On 5/8/25 at 10:35 AM, the surveyor observed Resident #213 walking in the hallway towards the activity room, appears well groomed. The surveyor reviewed the medical record for Resident #213. A review of the Resident's face sheet (admission summary) revealed diagnosis which included but was not limited to Alzheimer's (progressive disease that affects memory, thinking and behavior) and dementia (declining memory and thinking skills. A review of the quarterly Minimum Data Set (MDS), an assessment tool, revealed the resident as rarely understood. [...]

Inspectors wroteC #NJ159085 C #NJ158716 Based on observation, interview, record review, and review of facility documentation, it was determined that the facility failed to follow the facility post fall procedure to ensure appropriate care was provided and there was no delay in treatment and ensure: a.) a supervisor was notified, b.) a physical assessment was completed and documented, c.) the physician was notified, and d.) the fall incident was documented in the medical record. This deficient practice occurred for 1 of 34 residents reviewed for quality of care (Resident #168) who had a history of falls, including a fall with a shoulder fracture on 11/30/21, and who sustained an unwitnessed fall when a noise was heard in Resident #168's room on 01/22/23 at 10:35 PM, and the Licensed Practical Nurse (LPN) found Resident #168 lying on the floor and transferred the resident back into bed. [...]

Inspectors wroteBased on observation, interview, record review, and review of pertinent facility documents it was determined, the facility failed to a.) transcribe a Physician's Order (PO) for a resident's multivitamin from 1/30/23 through 3/29/23 for (Resident #330); b.) obtained a PO for a dietary supplement from 11/1/22 through 2/6/23 for (Resident #90). This was idenified for two (2) of thirty-six (36) residents reviewed for professional standards of practice; and c.) obtain a re-weight on 11/2/22, 12/5/22 and 1/19/23, after a significant change of weight for one (1) of seven (7) residents, (Resident #90) reviewed for nutrition. This deficient practice was evidenced by the following: Reference: New Jersey Statutes Annotated, Title 45. Chapter 11. Nursing Board. The Nurse Practice Act for the State of New Jersey states: [...]

Inspectors wroteBased on observation, interview, record review and review of pertinent documents it was determined that the facility failed to ensure safety measures were consistently followed for a resident who required a two- person transfer with a mechanical lift. This deficient practice occurred for 1 of 12 residents reviewed for accidents (Resident #5) and was evidenced by the following: On 03/29/23 at 10:27 AM, the surveyor conducted a tour of the Unit-8 Korean Unit and observed a Certified Nurse Aide (CNA) exit a resident room and enter another resident room across the hall where a Recreation Aide (RA) was visiting a resident. The CNA then stated to the RA, Can you stand by me? The surveyor observed both staff then enter the resident room across the hallway (Resident #5) and then closed the door. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to maintain resident care equipment and personal items clean and sanitary for 1 of 35 residents (Resident #30) reviewed for safe, clean, comfortable, and homelike environment. This deficient practice was evidenced by the following: On 3/23/21 at 10:45 AM during the initial tour of unit 11-2, the surveyor observed Resident #30 in the bed with eyes closed. There was a tube feeding (TF) pole and feeding pump at the bedside providing the resident with nutritional support. The surveyor observed the base of the TF pole had a heavily soiled coating of dried tan colored substance and the floor under the TF pump was soiled with the same dried substance observed at the base. [...]

Inspectors wroteBased on observation, interview, and review of facility documents it was determined that the facility failed to store a controlled substance in a manner that would decrease the possibility of loss or drug diversion. This deficient practice was found in 1 of 27 medication carts inspected (cart #2 on Unit 11-5) and was evidenced by the following: On 3/24/21 at 9:40 AM, the surveyor inspected medication cart #2 (1 of 2 medication carts) on Unit 11-5 in the presence of the Licensed Practical Nurse (LPN) assigned to that cart. Upon inspection of the top drawer of the cart the surveyor observed 1 Tramadol 50 mg pill (an opioid analgesic/controlled substance) in its unit dose packaging under a container that held an opened vial of insulin. The surveyor asked the LPN if she noticed the pill was there when she took possession of the medication cart that morning. She stated she did not notice it. [...]