Careone at Hanover Township

Inspectors wroteComplaint # 2569488 Based on interviews, record reviews, and facility policy reviews, it was determined that the facility failed to obtain a physician's order to ensure consistent provision of a customized Total Parenteral Nutrition (TPN; a unique mix of proteins, carbohydrates, fats, vitamins, minerals, and fluids delivered intravenously (IV; delivered directly into the bloodstream through a vein) for 48 hours which included 50 milliequivalents (meq) of Potassium Chloride (KCl), as well as interruption of the TPN (greater than 12 hours of missed hydration) which resulted in Resident #1's hospitalization for electrolyte abnormalities, that included severe hypokalemia (low potassium level), metabolic alkalosis (caused by volume depletion) and acute kidney injury. [...]

Inspectors wroteBased on observations, interviews, record review, and review of other facility documents, it was determined that the facility failed to provide pharmaceutical services in accordance with professional standards to ensure a.) provision of routine medication for administration (Resident #267) b.) accurate administration of medication for Resident #3, c.) documentation of removal of a controlled dangerous substance (narcotic; with high potential for drug diversion) medication from inventory, maintained accountability, and accurate reconciliation of Resident #43 and #50's narcotic medications, that was identified during the medication storage inspection of 2 of 2 medication carts. The deficient practice was evidenced by the following: On 4/14/25 at 8:13 AM, the surveyor observed Licensed Practical Nurse (LPN #1) begin to prepare 8 medications for Resident #267. [...]

Inspectors wroteBased on observation, interview, and review of pertinent facility documents, it was determined that the facility failed to maintain the call bell within reach of the resident and ensure that the side rail padding was in place. This deficient practice was identified for 1 of 19 residents reviewed for accommodation of needs (Resident #52), and was evidenced by the following: On 4/16/25 at 10:18 AM, the surveyor observed Resident #52 in bed, with his/her eyes open. Resident #52 did not respond to the surveyor's greeting. The surveyor observed that the resident's call bell (a bell used to summon staff for assistance) was not visible. The surveyor also observed that the resident's padding to the right upper half siderail was not placed correctly and was hanging down onto the floor. The surveyor reviewed the medical record for Resident #52. [...]

Inspectors wroteBased on observation, interview, and review of other facility documentation, it was determined that the facility failed to maintain a safe, clean, and homelike environment. This deficient practice was identified for 2 of 19 residents (Resident # 18 and # 19) and was evidenced by the following: 1. On 4/15/25 at 11:35 AM, during an interview with the surveyor, Resident #18 stated his/her privacy curtain was soiled, and it was very upsetting as this was his/her home and that he/she liked things to be nice and clean. At that time, the surveyor observed that the privacy curtain was soiled with several brown stains. The surveyor reviewed the medical record for Resident #18. A review of the admission Record reflected Resident #18 was admitted to the facility with diagnoses that included but were not limited to; diabetes mellitus and repeated falls. [...]

Inspectors wroteBased on observation, interview, and record review it was determined that the facility failed to accurately code the Minimum Data Set (MDS), an assessment tool used to facilitate the management of care, in accordance with federal guidelines for 4 of 19 residents, (Resident #6, #14, #37 and #66). This deficient practice was by the following: Reference: A review of the CDC's Advisory Committee on Immunization Practices (ACIP) for Pneumococcal Vaccine Recommendations dated/last reviewed on 10/26/24, included the following. The CDC recommended administration of pneumococcal conjugate vaccine (PCV20 or PCV21) at least 1 year for all adults 50 years or older who have received PCV 13 only at any age. 1. On 4/13/25 at 11:07 AM, during the initial tour, the surveyor observed the resident in bed. [...]

Inspectors wroteBased on observation, interview, record review, policy review and review of manufacturer's instruction, the facility failed to sanitize the glucometer, that were used for more than one resident, before and after each resident's use. The facility failed to properly sanitize the glucometer used on three (Resident (R)124, R17 and R36) residents from a sample of 28 residents. On 01/24/24 at 8:01 PM, the Administrator and Director of Nursing (DON) were notified that an Immediate Jeopardy existed at F880-J Infection Control due to the failure to sanitize multi-use glucometer between residents per manufacturer's instructions. The facility provided an acceptable Removal Plan which included retraining and ensuring competency of all Licensed Practical Nurses (LPNs) and Registered Nurses (RNs) on the use and sanitization of glucometers. [...]

Inspectors wroteBased on observation, interview, record review and policy review, the facility failed to ensure that a resident who entered the facility without a pressure ulcer received care and services to prevent the development of a pressure ulcer for one (Resident (R) 68) of three residents reviewed for pressure ulcers in a total sample of 28. This failure caused R68 to develop an unstageable sacral pressure ulcer. Additionally, after the development of the unstageable pressure ulcer, the facility staff failed to turn and reposition two of three residents (R68 and R17) and failed to use a low air loss pressure mattress as ordered to promote healing of R68's pressure ulcer.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure a resident received appropriate treatment and services to prevent a decline in range of motion for one of two residents (Resident (R) 1) sampled for mobility in a sample of 28 residents. This failure caused the resident to develop a contracture of her right hand.

Inspectors wroteBased on record review, interview, and policy review, the facility failed to thoroughly investigate the falls for two Residents (R)39 and R76) from a sample of 28 residents. R 39 fell and sustained a hip fracture requiring surgical intervention. The facility failed to investigate the cause of the fall that caused the hip fracture. Additionally, the facility failed to lock the bed's wheels when transferring R76 back to the bed resulting in R76 sustaining a fall.

Inspectors wroteBased on interview, record review and policy review, the facility failed to update one resident's (R)47) status by completing a significant change Minimum Data Set (MDS) assessment when R47 was admitted to hospice care on 01/05/24. This failure affected one of five residents reviewed for MDS assessment concerns, in a sample of 28 residents.

Inspectors wroteBased on observation, record review, interviews, review of facility policy, and review of the Resident Assessment Instrument (RAI) Manual, the facility failed to ensure three residents (Resident (R)4, R14, and R17) out of 28 sampled residents had an accurate Minimum Data Set (MDS) assessment.

Inspectors wroteBased on record review and interview, the facility failed to revised/update care plans for two Residents (R )39 and R74 from a sample of 28 residents. The facility failed revised R39's care plan to reflect a fall with a significant injury and R74's care plan regarding tracheotomy care.

Inspectors wroteBased on interviews and record review the facility failed to update the physician's orders to accurately reflect the respiratory care and services for one resident (R)74 of three residents reviewed for respiratory care and services in the sample of 28 residents

Inspectors wroteBased on interview, record review and document review, the facility failed to explain to residents the binding arbitration agreement and failed to inform the resident of the right to rescind the agreement within thirty calendar days for three (Resident (R) 224, R225, and R226) of three residents reviewed for arbitration agreement in a total sample of 28 residents.

Inspectors wroteBased on observation, interview and review of medical records and other pertinent facility documentation, it was determined that the facility failed to: a.) initiate a timely and through investigation for two injuries of unknown origin, and b.) ensure the facility policy for Investigating Injuries and Abuse Investigation and Reporting 1 of 3 residents (Resident #7) reviewed for investigations. The deficient practice was evidenced by the following: On 08/30/21 at 9:48 AM, the surveyor observed Resident #7 lying in bed. The resident was alert and was confused. The surveyor observed a black-blue discoloration located on the left forehead. Upon surveyor interview, Resident # 7 was unable to describe how the black and blue discoloration occurred to his/her left forehead. The surveyor reviewed the resident's electronic medical record (EMR) which revealed the following: [...]

Inspectors wroteBased on observation, interview and review of medical records, it was determined that the facility failed to provide physician ordered treatments, consistent with professional standards of clinical practice. This deficient practice was identified for 2 of 17 residents reviewed (Residents #34 and #23) and was evidenced by the following: Reference: New Jersey Statutes, 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 other pertinent facility documentation, it was determined that the facility failed to provide a safe environment to prevent the potential spread of infection by failing a.) to utilize the proper personal protective equipment (PPE) for residents on transmission-based precautions (TBP) for 4 of 5 (Resident #39, #210, #311, #29) resident reviewed for TBP, and b.) to adhere to infection control practices for hand hygiene to prevent the spread of infection during observation of a wound care treatment for 1 of 1 (Resident #29) reviewed. This deficient practice was evidenced by the following: A. 1.) On 08/30/21 at 9:24 AM, the facility informed the survey team that residents who were positive for COVID-19 were located on the first floor in a Red Zone area. [...]

Inspectors wrote2. During the initial tour on 08/30/21 at 9:30 AM, the surveyor observed Resident #18 in bed, with oxygen in place. The Oxygen was connected to a device delivering humidified air via nasal cannula. The setting on the device was 2 liters. The humidifier bottle was almost empty and had a sticker dated 07/24/21. The connected tubing was not labeled or dated. On 08/31/21 at 7:40 AM the surveyor observed Resident #18 sitting in the room, Resident #18 told the surveyor that she had a bad night and had to use the oxygen almost all night. On 09/01/21 at 9:25 AM, the surveyor observed Resident #18 sitting in a chair in the room eating breakfast. The Oxygen tubing was noted on the bed underneath the pillows, not labeled or dated. The sticker on the humidifier bottle still dated 07/24/21. A review of Resident #18's clinical record revealed the following: [...]

Inspectors wroteBased on observation, interview and record review, it was determined the facility failed to ensure that medications received from residents, specifically a controlled schedule IV drug, were verified and accounted for daily by incoming and outgoing staff. This deficient practice was identified for 1 of the 3 medication carts reviewed and was evidenced by the following: During the Medication Pass Administration observation on 08/31/21 at 9:30 AM, the surveyor conducted a narcotic count with the Registered Nurse (RN ) responsible for the medication cart on the high side. The surveyor observed 2 bottles of medication stored in the locked narcotic compartment. The medication was labeled as Tramadol 50 milligrams (mg) and Klonopin 0.5 mg. The medication belonged to Resident #10 who still resided at the facility and were brought to the facility by the resident on admission. [...]