Clover Rest Home

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to ensure that oxygen tubing was stored in accordance with infection control measures. This was found with 1 of 2 residents who received oxygen therapy, Resident #180. The deficient practice was evidenced by the following: On 5/1/25 at 11:25 AM, the surveyor observed Resident #180 in the day room participating in the activities. The surveyor observed a portable oxygen tank on the back of the wheel chair with oxygen tubing including the nasal cannula (NC) portion of tubing hanging off the tank, touching the floor and was not in use and not stored in a bag. The surveyor interviewed the Certified Nursing Assistant (CNA), who stated that the tubing should not have been on the floor. The CNA picked the tubing up off of the floor and put it into the small plastic baggie. [...]

Inspectors wroteBased on observations and interview on 01/25/2024 and 01/26/2024, it was determined that the facility failed to provide at least 80-square feet per Resident bed in multi-bedded rooms or 100-square feet in a single bedded room as evidenced by the following: On 01/25/2024 during the survey entrance at approximately 10:01 AM, a request was made to the Administrator and Director of Maintenance (DOM) to provide a copy of the facility lay-out which identifies the various rooms and smoke compartments in the facility. A review of the facility provided lay-out identified the facility is a three-story (3) building with a basement. There are eighteen (18) Resident sleeping rooms and common areas on the first floor. Starting on 01/25/2024 at approximately 10:40 AM, in the presence of the facility's DOM, the surveyor observed, measured and recorded the following Resident rooms: A-Wing Resident rooms: [...]

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 1 of 15 residents, Resident #8 reviewed for accuracy for MDS coding. This deficient practice was evidenced by the following: On 1/22/24 at 11:41 AM, the surveyor observed Resident #8 sitting in a wheelchair with other residents in the day room for recreational activity. The resident was resting in the wheelchair with there eyes closed. There was no urinary catheter observed. On 1/24/24 at 9:40 AM, the surveyor reviewed the electronic and paper medical record for Resident #8. [...]

Inspectors wroteBased on observation, interview, and review of medical records, it was determined that the facility failed to follow professional standards of practice by a.) not acquiring physician's order (PO) for the administration of Oxygen, b.) not administering the medication as ordered by the Physician and c.) by not following the facility's policy for (Peripherally Inserted Central Catheter) PICC line medication administration. This deficient practice was observed for 1 of 15 residents reviewed, Resident #19, Resident #5 and Resident #127 as 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: The practice of nursing as a licensed practical nurse is defined as performing tasks and responsibilities within the framework of case finding; [...]

Inspectors wroteComplaint NJ #: 163054 Based on interview and review of the Nurse Staffing Report it was determined that the facility failed to ensure that a required Registered Nurse (RN) was present at the facility 7 days a week for at least 8 consecutive hours a day for 4 of 14 days reviewed. This deficient practice was evidenced by the following: Per the Interpretive Guidance §483.35(b) Facilities are responsible for ensuring they have an RN providing services at least 8 consecutive hours a day, 7 days a week. However, per Facility Assessment requirements at F838, §483.70(e), facilities are expected to identify when they may require the services of an RN for more than 8 hours a day based on the acuity level of the resident population. If it is determined the services of an RN are required for more than 8 hours a day. Facilities may choose to have differing tours of duty (e.g. [...]

Inspectors wroteBased on observation, interview, and review of facility policies, it was determined that the facility failed to maintain proper kitchen sanitation practices to prevent food borne illness. This deficient practice was observed and evidenced by the following: On 1/22/24 at 9:10 AM, the surveyor in the presence of the Food Service Director (FSD), observed the following during the kitchen tour: 1. In the food preparation area, the surveyor observed the microwave with a white and yellowish debris throughout the microwave. 2. Next to the refrigerator/freezer the surveyor observed an Air Condition (AC #1) unit with a heavy buildup of a brown colored dust-like debris on the air outlet grill of the AC. 3. Above the 3 compartment sink, the surveyor observed AC #2 with a heavy buildup of a brown colored dust-like debris on the air outlet grill of the AC. [...]

Inspectors wroteBased on interviews, record review, and facility policy review, it was determined that the facility failed to develop a comprehensive care plan with interventions for a diagnosis and medication management for type two diabetes mellitus for one (Resident #27) of 12 residents reviewed for care planning. This deficient practice had the potential to affect all residents.

Inspectors wroteBased on record review, staff interviews, and facility policy review, it was determined the facility failed to revise and update a care plan related to a nephrostomy tube for one (Resident #10) of 12 residents reviewed for care planning.

Inspectors wroteBased on observations and staff interviews, it was determined that the facility failed to provide at least 80 square feet per resident bed, in multi-bedded rooms.