Careone at Middletown

Inspectors wroteBased on interview and document review it was determined that the facility failed to have a system in place to ensure quarterly financial statements were provided to residents or resident representative (RR) for residents who maintained Personal Needs Accounts (PNA) with the facility. This deficient practice was identified for 3 of 3 residents and affected all 42 residents identified as maintaining a facility PNA account. The evidence was as follows:On 05/18/26 at 10:28 AM, the surveyor conducted a resident council meeting with 5 residents. When asked if the residents were provided with quarterly financial statements for their PNA accounts, One of five residents (Resident #69) had PNA funds held by the facility, and stated No, the facility had never provided them with a quarterly financial statement. [...]

Inspectors wroteBased on interview and review of documentation it was determined that the facility failed to have a system in place to ensure residents or resident responsible parties were notified that the funds held by the facility in their Personal Needs Account (PNA) reached the $2,000 maximum Supplemental Security Income (SSI) or $200 less of the maximum which could jeopardize their eligibility for SSI or Medicaid. This deficient practice was identified for 2 of 2 (Resident #29 and Resident # 76) reviewed for PNA, and affected all 42 residents who had a PNA account held by the facility. The evidence was as follows:On 5/18/26 at 12:00 PM, a review of the facility provided Trial Balance report revealed one resident PNA balance was over the $2,000 SSI maximum and one of the balances were over $1,800 which was $200.00 less than the $2,000 maximum. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to ensure a) adequate supervision was provided to a resident with documented behaviors of wandering into other residents rooms (Resident #26), b) targeted fall interventions were identified and implemented in response to falls, and c) current care plan interventions to prevent accidents were implemented. This deficient practice occurred for 2 of 3 residents reviewed (Resident #23 and #26) for accidents and was evidenced by the following: 1. On 5/19/26 at 8:20 AM, the surveyor toured the unit where Resident #23 resided and observed the resident in bed, and the Certified Nurse Aide (CNA) was in the room and informed the surveyor that the resident was confused. [...]

Inspectors wroteComplaint #NJ 3001928Based on observations, interviews and record reviews, it was determined that the facility failed to ensure that a resident was assessed for the appropriate call bell device and the device was within the resident's reach. This deficient practice was identified for 1 of 2 residents reviewed for call bell (Resident #62) and was evidenced by the following:On 5/19/26 at 8:59 AM, the surveyor observed Resident #62 in bed, their eyes were closed, and the call bell was observed on the bedside table and out of reach of the resident. [...]

Inspectors wroteBased on observation, interview, record review, and review of facility provided documents, it was determined that the facility failed to consistently provide appropriate and timely incontinence care for residents who were dependent on staff assistance for care. This deficient practice was identified for 2 of 3 residents (Resident # 22 and Resident #62) reviewed for activities of daily living (ADL) care and was evidenced by the following: included:On 5/18/22 at 10:00 AM, the surveyor toured the unit and inquired regarding the care received by Resident #22 who informed the surveyor that during the 3:00 PM-11:00 PM shift incontinence care was not provided in a timely manner. The resident stated, you have to urinate 3 to 4 times in the brief before you can get changed.1. On 5/19/26 at 9:15 AM, the surveyor observed Resident #22 lying in bed in their room. [...]

Inspectors wroteComplaint # 2600008 Based on interviews, record review and review of pertinent facility documents, it was determined that the facility failed ensure that a Registered Nurse (RN) documented a resident's assessment after a fall occurred. This deficient practice was identified for 1 of 2 residents reviewed for falls (Resident #101). 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 facility documents, it was determined that the facility failed to obtain a physician's order for removal of a BIPAP (Bilevel Positive Airway Pressure- a type of non-invasive mechanical ventilation that delivers two different pressurized air levels through a mask) and ensure accuracy for the orders to change a BIPAP mask and tubing. This deficient practice was identified for 1 of 1 resident (Resident #9) reviewed for respiratory care and was evidenced by the following: On 5/18/26 at 10:40 AM, during an initial tour, the surveyor observed Resident #9 lying in their bed. A BIPAP machine was on their nightstand. The surveyor then reviewed the Electronic Medical Record (EMR) for Resident #9 which reflected the following: [...]

Inspectors wroteBased on observation, interview and document review it was determined that the facility failed to failed to maintain the kitchen environment and equipment in a sanitary and properly functioning manner to prevent potential contamination and or the spread of potential food borne illness. This deficient practice was evidenced by the following: On 01/07/25 at 9:51 AM, the surveyor conducted a tour of the kitchen with the Food Service Director (FSD) and observed the following: 1. The metal baffles that were inside of the exhaust hood, and above the cooking battery, were visibly soiled with black debris in the slats of the baffles. There was visible grease and grime located on the bottom of the baffles and there was grease type droplets affixed to the opposite inside of the hood. [...]

Inspectors wroteBased on observations and interviews between 01/08/2025 and 01/10/2025 in the presence of the Maintenance Assistant (MA), Regional Director of Maintenance (RDOM) and Senior Regional Director of Maintenance (SRDOM), it was determined that the facility failed to ensure that the resident call bell system properly functioned .This deficient practice had the potential to affect all residents and was evidenced by the following: An observation on 01/09/2025 at 10:14 AM revealed, when the call bell was tested for room [ROOM NUMBER], it did not send a signal of activation to the nurse's station on unit 3. The call bell annunciator was showing an ERROR CONNECTIVITY signal at the desk. An observation at 10:22 AM revealed, when the call bell was tested for room [ROOM NUMBER], it did not send signal of activation to the nurse's station on unit 3. [...]

Inspectors wroteBased on observation, interview and record review it was determined that the facility failed to update resident Care Plans for Activities for 2 of 2 residents reviewed for activities (Resident #26 and Resident #2). The deficient practice was evidenced by the following: a) On 01/06/25 10:46 AM, Resident #26 was observed in bed and was alert. The surveyor tried to engage the resident in conversation and the resident spoke Spanish. There were no activities observed in progress in the room, or any Spanish language materials for the resident. On 01/06/25 at 12:24 PM, the surveyor interviewed the Certified Nurse Aide (CNA) assigned to resident #26. There was a sheet observed with boxes in Spanish and Pictures to help communicate with the resident and was located on the bedside table. [...]

Inspectors wroteBased on observation, interview, and review of pertinent documentation, it was determined that the facility failed to a.) ensure activity assessments accurately reflected the needs of all residents and appropriate activities were provided for a non-English speaking resident (Resident #26), and b.) complete a yearly activity assessment and activity monitoring to determine the meaninful interests of a resident (Resident #24), hobbies, and cultural preferences. This deficient practice occurred for 2 of 2 residents reviewed for resident activities and was evidenced by the following: a) On 01/05/24 at 12:47 PM, the surveyor observed Resident #26 sitting in the wheelchair in the Day Room of Station 1. Resident #26 was at a table by themselves, next to a wall, awake and alert with no activities observed in front of the resident, and no activity staff were present. [...]

Inspectors wroteBased on observation, interview, and review of pertinent documents it was determined that the facility failed to ensure a system was in place to inspect the emergency crash carts (ECC) for expiration dates and placement. This deficient practice was identified on 3 of 3 Resident Sections (1,2,3) and was evidenced by the following: On [DATE] at 12:17 PM, Surveyor #1 and Surveyor #2 were on Section 1 unit. The Automatic External Defibrillator (AED) was located in a cabinet on the wall. Across from the AED, the ECC was located. At that time, the Licensed Practical Nurse Infection Preventionist (LPN IP) was on the unit. Surveyor #2 inspected the ECC and found it was locked. There were items on top of the ECC which included the checklist. A review of the ECC checklist revealed the following items were not documented as having been checked: [...]

Inspectors wroteBased on observation, interview, and review of pertinent facility documents, it was determined that the facility failed to maintain infection control standards and procedures to address the risk of infection transmission by failing to: a) follow Contact isolation precautions for a resident who was on Transmission Based Precautions (TBP) (Resident #42), b) ensure that resident's indwelling urinary catheter drainage bag was stored properly for 1 of 1 resident reviewed for urinary catheter (Resident #47), and c) perform hand hygiene during meals according to the facility policy. This deficient practice occurred on 2 of 3 resident units (Section 1 & 2) and was evidenced by the following: 1. On 1/5/24 at 7:19 AM, during the initial tour, the surveyor observed a Contact Precaution signage and personal protective equipment (PPE; equipment (gowns, gloves, masks, etc. [...]

Inspectors wroteBased on observation, interview, record review, and review of other pertinent facility provided documentation, it was determined that the facility failed to follow the physician orders for medications (meds) that required parameters. This deficient practice occurred for 1 of 18 residents (Residents #62) reviewed for medications and was evidenced by the following: 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, and record review, it was determined that the facility failed to provide the necessary services to maintain adequate grooming for a resident who was dependent on the staff for activities of daily living. This deficient practice was observed for 1 of 19 residents reviewed for care (Resident #125) and was evidenced by the following: On 01/05/25 at 9:07 AM, the surveyor observed Resident #125 lying in bed. Resident #125's facial area was covered with long thick facial hair. Resident #125 was positioned on the left side and the head of the bed was slightly elevated. On 01/05/25 at 11:30 AM, the surveyor observed the resident still laying on the left side as observed at 9:07 AM. The surveyor left the room and reviewed the assignment sheet. The surveyor located the Certified Nursing Assistant (CNA #1) assigned to Resident #125. [...]

Inspectors wroteComplaint#: NJ00181485 Based on observation, interview, and record review and review of other facility documentation on 12/23/24 and 12/24/24, it was determined that the facility failed to develop and implement baseline care plan (BCP) within 48 hours of admission that included the minimum healthcare information necessary to properly care for the immediate needs of the resident. This practice was identified for 1 out of 6 residents (Resident #1) reviewed. This deficient practice was evidenced by the following: Resident #1 was not in the facility at the time of the survey. A closed medical record review was conducted. The surveyor reviewed the admission Record which revealed that Resident #1 was admitted with the diagnoses which included but were not limited to spinal stenosis (spaces inside the bones of the spine that get too small), atherosclerotic heart disease, type 2 diabetes. [...]

Inspectors wroteComplaint#: NJ00181485 Based on observation, interview, and review of medical records and other pertinent facility documentation on 12/23/24 and 12/24/24, it was determined that the facility failed to maintain a safe enviornment, keep a resident free from hazards, and provide the necessary monitoring and supervision for a resident who was found to have ligature marks around the neck. This deficient practice was identified for 1 of 6 residents (Resident #1) reviewed and was evidenced by the following: Resident #1 was no longer at the facility at the time of the survey. A closed record review was conducted. A review of the admission Record revealed that Resident #1 was admitted to the facility with diagnoses that included but were not limited to: spinal stenosis (spaces inside the bones of the spine that get too small), atherosclerotic heart disease, and Type 2 diabetes. [...]

Inspectors wroteComplaint#: NJ00181485 Based on interviews, review of the medical records, as well as review of other pertinent facility documentation on 12/23/24 and 12/24/24, it was determined that the Director of Social Services (DSS) failed to develop and implement policies and procedures for the identification of medically related social and emotional needs for a resident and assist a resident in obtaining needed services from outside entities, as required by the facility's job description for the Director of Social Services. This deficient practice was identified for 1 of 6 residents (Resident #1) reviewed and was evidenced by the following: Resident #1 was no longer at the facility at the time of the survey. A closed record review was conducted. A review of the admission Record revealed that Resident #1 was admitted to the facility with diagnoses that included but were not limited to: [...]

Inspectors wroteComplaint #: 168416 Based on interview and review of facility documents it was determined that the facility failed to conduct a thorough investigation to address an allegation of abuse according to their Reporting and Investigating Policy. This deficient practice was identified for 1 of 6 residents (Resident #2), and was evidenced by the following: Resident #2 no longer resides at facility, on 12/23/24, a closed record review of Resident #2's medical record was completed. The surveyor reviewed Resident #2's clinical record. The admission Record indicated that Resident #2 was admitted to the facility with diagnoses which included but not limited to: [...]

Inspectors wroteComplaint#: NJ00181485 Based on observation, interview and review of medical records and other pertinent facility documents it was determined that the facility failed to maintain accurately documented and complete medical records in accordance with acceptable standards and practice by a.) not documenting attempts to complete psychological assessment and b.) not documenting weights for a new admission. This deficient practice was identified for 1 of 6 residents (Resident #1) as evidenced by the following: Resident #1 was not at the facility at the time of the survey. A closed medical record review was conducted. The surveyor reviewed the admission Record which revealed that Resident #1 was admitted with the diagnoses which included but were not limited to spinal stenosis (spaces inside the bones of the spine that get too small), atherosclerotic heart disease, and type 2 diabetes. [...]

Inspectors wroteBased on observations, interviews, document review, and facility policy review, the facility failed to provide a nourishing snack at bedtime when there was more than 14 hours between a substantial evening meal and breakfast the following day for 53 of 88 residents.

Inspectors wroteBased on record review, interviews, and facility policy review, it was determined the facility failed to ensure a resident received treatment and care in accordance with professional standards of practice for one (Resident #12) of one resident reviewed for urinary catheter care and services. Specifically, the facility failed to ensure staff arranged a timely urology appointment for Resident #12 to facilitate potential removal of an indwelling urinary catheter.

Inspectors wroteBased on record review, interviews, and facility policy review, the facility failed to ensure each resident received adequate supervision and assistive devices to prevent accidents for 1 (Resident #12) of 3 residents reviewed for falls. Specifically, the facility failed to ensure a thorough investigation was done to include a root cause analysis after Resident #12 had multiple falls on 01/20/2023, 01/21/2023, 01/24/2023, 01/25/2023, and 02/07/2023.

Inspectors wroteBased on observation, record review, facility policy review, and interviews, it was determined the facility failed to address the Registered Dietician (RD)'s recommendation for 1 (Resident #46) of 2 residents reviewed for nutrition.

Inspectors wroteBased on observations, interviews, and facility policy review, the facility failed to ensure 1 (medication cart for Rooms 1-18) of 4 medication carts were locked on two occasions to prevent unauthorized access.