Complete Care at Brick LLC

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure dignity during dining for one of 26 sampled residents (Resident (R)85) when staff stood while feeding the resident. This failure could cause humiliation, loss of self-worth, and increase the risk of choking and/or aspirating food or liquid into the lungs.

Inspectors wroteBased on record review, interviews, and review of the facility's policy, the facility failed to ensure the code status was updated in the electronic medical record (EMR) to match the code status ordered for one of 26 sample residents (Resident (R) 78) reviewed for code status. The deficient practice could result in a resident who did not want to be resuscitated receiving cardiopulmonary resuscitation.

Inspectors wroteBased on observation, interviews, record review, and facility policy review, the facility failed to develop and implement a baseline care plan that included instructions needed to provide effective and person-centered care related to dialysis within 48 hours of admission for one of 26 sample residents (Resident (R) 51) reviewed for baseline care plans. Failure to develop and implement a baseline care plan could place residents at risk for unmet care needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop person centered comprehensive care plans for out-patient therapy, dialysis, and/or a dialysis catheter for two of four residents (Resident (R)51 and R5) reviewed for care plans out of a total sample of 26. This placed the residents at risk for decreased quality of life and quality of care.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure regularly scheduled care conferences were conducted and residents were invited to participate in their care plan processes for two of four residents (Residents (R) 68 and R9) reviewed for care planning out of a total sample of 26. The deficient practice had the potential to cause poor health decisions and treatment and decrease resident satisfaction with care.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to provide care for a dialysis catheter after dialysis was discontinued for one of three residents (Resident (R) 51) reviewed for dialysis and failed to ensure the wound vac settings were correct for one of one resident (R97) reviewed for wound vac of 26 sample residents. The deficient practice has the potential to cause infection or tissue damage.

Inspectors wroteBased on observation, interview, record review, and review of facility policy, the facility failed to ensure one of three sampled residents (Resident (R) 6) reviewed for entrapment hazards did not have a large gap between their side rail and mattress. Large gaps between the siderails and the mattress have the potential to entrap the resident which could cause strangulation death or injury.

Inspectors wroteBased on observation, interview, record review, and review of policies and procedures, the facility failed to provide a packed meal for dialysis according to the physician order for one of four residents (Resident (R) 100) reviewed for dialysis out of a total sample of 26. Failure to provide a diabetic and renal patient meals could result in a change in blood sugar levels or kidney function.

Inspectors wroteBased on observation, record review, interviews, and review of policies and procedures, the facility failed to assess the entrapment risk of a new perimeter mattress used to prevent falls for one of three residents (Resident (R)6) reviewed for accident hazards out of a total sample of 26. Failure to assess and determine hazards could lead to injury, entrapment, or death.

Inspectors wroteBased on observations, record review, interview, and facility policy review, the facility failed to ensure one of four residents (Resident (R) 46) observed for medication administration was free from significant medication errors when R46 did not receive the correct ordered dosage of Gleevec (a chemotherapy, cancer treatment medication) of 26 sample residents. This failure had the potential to cause adverse drug reactions with the lack of effectiveness of the medications in the event of underdosing.

Inspectors wroteComplaint # NJ169666, NJ170088, NJ167481 Based on observation, interview, and review of the medical records and other facility documentation, it was determined that the facility failed to ensure that incontinence care was provided to dependent residents in a timely manner. This deficient practice was identified for 3 of 3 residents (Residents #23, #30 and #12) on 1 of 2 nursing units (Starlight Unit) observed for incontinence care and was evidenced by the following: Refer to F725 1.) On 05/20/24 at 9:17 AM, the surveyor interviewed the Licensed Practical Nurse/Unit Manager (LPN/UM) who stated the unit census was 42 residents, six (6) aides and three (3) nurses. On 05/20/24 at 9:23 AM, the surveyor interviewed Certified Nursing Assistant (CNA) #1 who stated that she was assigned to nine (9) residents. [...]

Inspectors wroteComplaint #: NJ 169584, 169666, 169916, 167481, and 170088 Based on observation, interview, and review of pertinent documents, it was determined that the facility failed to ensure there was sufficient nursing staff on a 24-hour basis in accordance with the facility assessment to a.) maintain the required minimum direct care staff-to resident ratios as mandated by the State of New Jersey, b.) provide appropriate incontinence care to dependent residents (Resident #12, #23 and #30), c.) provide residents with scheduled showers (Resident #45), and d.) prevent the increase of falls for (Resident #9, #56, #232, #233, #234, #235, #236, #237, #238, #241 and #242). This deficient practice was identified for 6 of 6 residents and 9 of 9 closed records reviewed, affected all residents on 2 of 2 units, and was evidenced by the following: Refer to F677 1.) Reference: [...]

Inspectors wroteBased on observation, interview, record review and review of pertinent facility documentation, it was determined that the facility failed to provide a gradual dose reduction (GDR) of psychoactive medication (mood altering drug) in the absence of targeted behaviors and obtain a psychiatric consult for the use of a psychotropic medication. This deficient practice was identified for 1 of 5 residents (Resident #24) reviewed for unnecessary medications and was evidenced by the following: According to the admission Record, Resident #24 was admitted to the facility with diagnoses which included, but were not limited to, depression and unspecified dementia with other behavior disturbances. The quarterly Minimum Data Set (MDS), an assessment that facilitates care, dated 03/04/24, indicated that Resident #24 was sometimes understood, and ability was limited to making concrete request. [...]

Inspectors wroteBased on observation, interview, and review of facility documentation, it was determined that the facility failed to a.) label, date, and store potentially hazardous foods appropriately to prevent food borne illness and b.) maintain kitchen equipment in a manner to prevent microbial growth. This deficient practice was evidenced by the following: On 05/15/24 at 09:52 AM, accompanied by the Licensed Nursing Home Administrator (LNHA), the surveyor made the following observations in the kitchen during the initial tour: 1.) The surveyor observed the can opener blade, shaft, and base of the can opener had sticky brown food particles throughout. The surveyor interviewed the Executive Chef (EC) at that time who stated that the can opener was usually cleaned daily, however, was not cleaned yet. 2.) The surveyor observed a large plastic bin of dry rice with scooper left inside the bin. [...]

Inspectors wroteComplaint # NJ169584 Based on interview, record review, and review of facility documents, it was determined that the facility failed to maintain medical records that were complete by not documenting the completion of medications and treatments for 3 of 22 (Resident #19, #131, and #182) sampled residents. This deficient practice was evidenced by the following: 1.) According to the admission Record (AR), Resident #19 was admitted with diagnoses which included, but were not limited to, end stage renal disease and dependence on renal dialysis. Review of the Quarterly Minimum Data Set (MDS), an assessment tool used to facilitate the management of care, dated 03/10/24, revealed that Resident #19 had a Brief Interview for Mental Status (BIMS) score of 14, which indicated the resident was cognitively intact. [...]

Inspectors wroteComplaint # NJ168787 Based on observation, interview, and review of medical records and other pertinent facility documentation, it was determined that the facility failed to a.) follow transmission-based precautions (TBP) to prevent the potential spread of infection by not utilizing personal protectice equipment (PPE) for a resident on contact precautions for 1 of 1 resident (Resident #63) reviewed for TBP, b.) obtain a physician's order to include a resident's transmission-based precautions (TBP) for 1 of 3 residents (Resident #182) reviewed for pressure ulcers, c.) maintain a resident's urinary catheter bag off the floor for 1 of 1 resident (Resident #5) reviewed for urinary catheter, and d.) test residents for influenza (flu) in accordance with the Center for Disease Control and Prevention (CDC) guidelines for 5 of 5 residents (Resident #2, #8, #231, #239, and #240) reviewed. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to provide care and services in a manner that maintained and promoted dignity by not applying an appropriate device to protect a resident's clothing for 1 of 19 residents (Resident #24) reviewed. This deficient practice was evidenced by the following: According to the admission Record, Resident #24 was admitted to the facility with the diagnoses which included, but were not limited to, depression and unspecified dementia with other behavior disturbances. The quarterly Minimum Data Set (MDS), an assessment that facilitates resident care, dated 03/04/24, indicated that Resident #24 was sometimes understood, and ability was limited to making concrete request and that the resident responded to simple direct communication, however able. [...]

Inspectors wroteComplaint # NJ168787 Based on interview, record review, and review of pertinent facility documents, it was determined that the facility failed to notify the resident's representative of a change in condition for 1 of 22 residents (Resident #231) reviewed. This deficient practice was evidence by the following: According to the admission Record, Resident #231 was admitted to the facility with diagnosis which included, but were not limited to, acute respiratory failure with hypoxia (a condition where you do not have enough oxygen in the tissues in the body), Alzheimer's Disease, and chronic obstructive pulmonary disease (COPD - a chronic inflammatory lung disease that causes obstructed airflow from the lungs). Further review of the admission Record included contact information for the resident's responsible party. [...]

Inspectors wroteBased on observation, interview, and review of pertinent facility documents, it was determined that the facility failed to keep a resident's room clean by placing a soiled incontinence brief in a garbage receptacle without a bag liner, leaving used disposable gloves on the floor, and not emptying a closed-lid garbage receptacle with exposed personal protective equipment. The deficient practice effected 2 of 7 residents (Resident #22 & #57) and was evidenced by the following: On 05/20/2024 at 12:09 PM, while visiting Resident #22 in his/her room, the surveyor observed a soiled incontinence brief in the garbage receptacle adjacent to his/her bed. The receptacle did not have a bag liner in it. The surveyor also observed a pair of inside-out disposable gloves on the floor. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to a.) provide services according to the resident's communication needs documented on the Care Plan (CP) and b.) update the CP to accurately reflect the communication needs for 1 of 1 resident (Resident #24) evaluated for communication. This deficient practice was evidenced by the following: According to the admission Record, Resident #24 was admitted to the facility with the diagnoses, which included but were not limited to, depression and unspecified dementia with other behavior disturbances. The quarterly Minimum Data Set (MDS), an assessment that facilitates resident care, dated 03/04/24, indicated that Resident #24 was sometimes understood, and ability was limited to making concrete request. The MDS also indicated that the resident responded to simple direct communication, however able. [...]

Inspectors wroteComplaint # NJ167481, NJ169584 Based on observation, interview, record review, and review of facility documents, it was determined that the facility failed to a.) ensure that an air mattress was accurately set according to the resident's weight, and b.) thoroughly investigate a facility acquired pressure ulcer. This deficient practice was identified for 2 of 3 residents (Resident #131 and #182) reviewed for pressure ulcers and was evidenced by the following: 1.) On 05/17/24 at 10:15 AM, the surveyor observed Resident #182 lying in bed asleep. The resident had an air mattress which was set to 280 lbs. (pounds). On 05/20/24 at 9:46 AM, the surveyor observed Resident #182 lying in bed asleep and the resident's air mattress was set to 280 lbs. On 05/21/24 at 9:30 AM, the survey observed Resident #182 lying in bed awake and the resident's air mattress was set to 280 lbs. [...]

Inspectors wroteBased on observation, interview, record review, and review of pertinent facility documents, it was determined that the facility failed to ensure a resident receiving enteral feeding received appropriate care and services to prevent complications of enteral feeding, specifically by having the enteral feeding pump running while disconnected resulting in nutritional formula dripping onto the floor, failing to replace the irrigation syringe every twenty-four hours, and failing to clean nutritional formula residue off of the pole supporting the enteral feeding pump. This deficient practice was identified for 1 of 1 resident (Resident #22) investigated for tube feeding and was evidenced by the following: According to the admission Record, Resident #22 had a diagnosis which included, but was not limited to, Unspecified Severe Protein-Calorie Malnutrition. [...]

Inspectors wroteBased on observation, interview, and pertinent record review, it was determined that the facility failed to ensure the accountability of the Narcotic Shift Count logs were completed in accordance with facility policy and accurately account for and document the administration of controlled medications. This deficient practice was identified on 2 of 3 medication carts and was evidenced by the following: On 05/16/24 at 11:44 AM, during medication storage observations, the surveyor, in the presence of Licensed Practical Nurse #1 (LPN #1), observed the controlled substances inventory and count logs for the Seabreeze nursing unit's medication Cart 3. The following was observed: Narcotic Shift Count log for May 2024 was missing a nursing signature for: [...]

Inspectors wroteBased on observation, interview, and review of pertinent facility documentation, it was determined that the facility failed to a.) properly secure medications during medication administration, and b.) properly secure a resident's home supply medications. This deficient practice was identified for 2 of 2 nurses observed during medication administration, and 1 of 1 resident (Resident #28) reviewed for pain management, and was evidenced by the following: 1.) On [DATE] at 8:34 AM, during medication administration observation, the surveyor observed Licensed Practical Nurse #1 (LPN #1) prepare to administer medications to Resident #21. [...]

Inspectors wroteBased on interview and review of pertinent facility documents, it was determined that the facility failed to ensure that the required members were present during the quarterly Quality Assurance and Performance Improvement (QAPI) Program committee meetings. This deficient practice occurred during 3 of the 4 quarterly QAPI meetings reviewed and was evidenced by the following: On 05/21/2024 at 09:40 AM, the surveyor interviewed the Licensed Nursing Home Administrator (LNHA) regarding the Quality Assurance Performance Improvement (QAPI) process in the facility. The surveyor reviewed the quarterly QAPI meeting sign in sheets in the presence of the LNHA. According to the quarterly sign in sheets provided by the facility, there was no Infection Preventionist (IP) in attendance at the quarterly QAPI meeting that was held on 04/18/2024. [...]

Inspectors wroteBased on observation, interview, and review of other facility documents, it was determined that the facility failed to handle potentially hazardous food and maintain sanitation in a safe and consistent manner to prevent food borne illness. This deficient practice was evidenced by the following: On 6/21/2022 from 9:37 AM to 10:24 AM, the surveyor, accompanied by the Food Service Director (FSD), observed the following in the kitchen: 1. In the walk-in freezer an opened bag of chicken fingers on a middle shelf had no dates. The FSD stated, They should be labeled with an open and use by date. 2. In the same walk-in freezer on a lower shelf, an opened package of frozen hash browns removed from its original container had no label or dates. On interview the FSD responded, Same thing. Needs an opened and use by date. [...]

Inspectors wroteBased on observation, interview, and review of other facility documentation, it was determined that the facility failed to perform adequate handwashing to prevent the spread of infection as well as failed to follow their own Hand Hygiene policy. This deficient practice was identified for 1 of 3 Licensed Practical Nurses (LPN) observed during medication administration. The deficient practice was evidenced by the following. On 06/24/22 at 8:19 AM, the surveyor observed the LPN begin medication administration for an unsampled resident. The LPN went to the resident room to obtain a blood pressure (BP) reading. After obtaining the BP reading, the LPN entered the resident's bathroom. At 8:20 AM, the surveyor observed the LPN turn on the faucet, wet her hands, apply soap, create friction outside the stream of water for 11 seconds, rinse her hands, dry her hands, and turn off the faucet. [...]