Gardens at Monroe Healthcare and Rehabilitation, T

Inspectors wroteBased on observations, interviews, record review and review of pertinent facility documents, it was determined that the facility failed to ensure that a.) two Certified Nurse Aides (CNA) on 2 of 4 Units ([NAME] and [NAME]) caring for Residents #54 and #340, removed (doffed) personal protective equipment (PPE) appropriately, and b.) 1 of 3 nurses wore their facemask properly on 1 of 4 units ([NAME]) caring for Resident #2, and in accordance with the Center for Disease Control (CDC) Guidance. This deficient practice was evidenced by the following: 1. On 4/03/25 at 11:57 AM, the surveyor observed CNA #1 enter Resident #340's room who was on transmission-based precautions (TBP) [process that is implemented to prevent the spread of infections]. CNA #1 was wearing a surgical mask and donned (put on) a gown, gloves and face shield prior to entering the room. [...]

Inspectors wroteBased on observation, 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 #10). 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 registered professional nurse is defined as diagnosing and treating human responses to actual or potential physical and emotional health problems, through such services as case finding, health teaching, health counseling and provision of care supportive to or restorative of life and wellbeing, and executing medical regimes as prescribed by a licensed or otherwise legally authorized physician or dentist. [...]

Inspectors wroteBased on observation, interview and record review, it was determined that the facility failed to provide pharmaceutical services in accordance with professional standards by not ensuring a.) an apical heart rate (pulse heard on the chest) was obtained before the medication Digoxin (a medication used to treat heart failure or rhythm problems) was administered by one (1) of three (3) nurses and b.) required vital sign parameters for a medication were obtained in a timely manner by one (1) of three (3) nurses who administered medications to two (2) of five (5) residents, (unsampled Residents #2 and #140), during the medication administration observation. The deficient practices were 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 interview, record review, and review of pertinent facility documentation, it was determined that the facility failed to accurately code a resident's Minimum Data Set (MDS), an assessment tool used to facilitate the management of care, for 1 of 21 residents (Resident #87) reviewed for accurately coding the MDS according to the Resident Asessment Instrument (RAI-used to assess and care plan residents). The deficient practice was evidenced by the following: On 04/07/25 at 10:30 AM, the surveyor reviewed the electronic medical record (EMR) for Resident #87. A review of the admission Record (an admission summary) revealed the resident was admitted to the facility with diagnoses which included but were not limited to; [...]

Inspectors wroteBased on interviews and review of pertinent facility documentation, it was determined that the facility failed to ensure a process was in place and followed to ensure untrained staff without sufficient competencies to meet the health and/or safety needs of one or more residents. [Non-permanent Nurse Aides (NAs)] were competent to provide resident care by failing to ensure: a.) NAs were full-time employees who were enrolled in a State- approved training and competency program, and b.) a system was in place to ensure all NAs received the appropriate training and deemed eligible to provide resident care, which included, but was not limited to; assisting with two person transfers, bathing and feeding dependent residents. [...]

Inspectors wroteBased on interviews, and review of facility documents, it was determined that the facility Licensed Nursing Home Administrator (LNHA) failed to a.) ensure policies and procedures were implemented and followed to ensure all agency employed Nurse Aides (NAs) were competent and eligible to provide direct resident care for 5 of 7 NAs who worked on 4 of 4 units and provided facility wide direct resident care from 09/04/22 through 04/20/23 and b.) follow the facility's abuse policy to ensure that all contracted NAs received criminal background check(s) prior to working at the facility and review information from licensing boards or other registries including for alleged foreign credentialed staff. The LNHA failed to to have a system in place to ensure that all staff were appropriately screened to ensure they have never been convicted of a crime or other disqualifying offences. [...]

Inspectors wroteOn 4/24/2023 at 12:25 PM, a review of Resident #55's Incident/Accident report dated 12/06/2022, revealed that on 12/06/2022 at 06:50 PM, the resident was noted to have a purplish discoloration below the left eye, on the eye bag area, medial side. No skin opening, surrounding skin intact; no swelling noted. The incident report indicated that Resident #55 was alert and oriented and able to verbalize needs, but not aware of how he/she sustained the bruise. The resident's medical doctor (MD) and family were notified of the incident. Further review of Resident #55's incident report indicated that the resident's condition before the incident was normal and that the exact location of the incident was the resident's room. [...]

Inspectors wroteBased on observation, interviews, review of medical records and other pertinent facility documents, it was determined that the facility failed to a.) ensure that there was consistent documentation of social service comprehensive assessments for 7 of 11 residents reviewed for social services (Resident's #4, #8, #10, #15, #35, #39, and #61) , and b.) clarify and accurately transcribe a physician's order for Ambien (a Sedative-Hypnotic) which resulted in a resident receiving the incorrect dose of the medication. This was identified for 1 of 25 residents (Resident #387) reviewed for medication management. The deficient practice was evidenced as follows: 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 facility documentation, it was determined that the facility failed to follow Physician Orders (PO) with regards to blood pressure medications with parameters for 1 of 25 residents (Resident #76) reviewed for medication management. This deficient practice was evidenced by the following: On 4/17/22 at 11:20 AM, the surveyor observed Resident #76 in the room and seated in a wheelchair watching television. The surveyor reviewed Resident #76's medical records. [...]

Inspectors wroteBased on interviews, record review, and review of pertinent facility documents, it was determined that the facility failed to ensure that residents' bathing choice of a daytime shower was provided for (2) two of (6) six residents (Resident #10 and #61) reviewed for choices during a resident council meeting on 4/19/23. This deficient practice was evidenced as follows: On 4/19/23 at 10:38 AM, a resident council meeting was conducted with six residents who resided on the [NAME] unit. During that meeting six of six residents expressed that residents required the most assistance during the 7 AM - 3 PM shift, and that at times it was difficult to get showered. Two of the six residents stated that they were scheduled to receive a shower that morning but were unable to be showered since they were told that the unit was short staffed. Record Review for Resident #10: [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to ensure the safety of the residents by allowing staff to shower residents in a non-resident certified area on 1 of 4 units. This deficient practice was evidenced by the following: On 4/17/23 at 11:25 AM, the surveyor toured the [NAME] Unit. On that same day at 11:40 AM, the surveyor observed a door held open via a magnet off the [NAME] unit. On 4/17/23 at 11:54 AM, the surveyor observed the same door open and attached to the magnet latch. At that same time, the Director of Nursing (DON) stated, the rooms beyond this door are rooms that were converted into staff aide rooms and there is a kitchen and a bathroom beyond the door. She further stated, it's an employee overnight area, an extension. [...]

Inspectors wroteBased on observation, interview, record review, and review of pertinent facility documentation, it was determined that the facility failed to report a bruise of unknown origin to the New Jersey Department of Health (NJDOH) as required for 1 of 13 residents (Resident #55) reviewed for abuse. This deficient practice was evidenced by the following: On 4/24/2023 at 12:25 PM, a review of Resident #55's Incident/Accident report dated 12/06/2022, revealed that on 12/06/2022 at 06:50 PM, the resident was noted to have a purplish discoloration below the left eye, on the eye bag area, medial side. No skin opening, surrounding skin intact; no swelling noted. The incident report indicated that Resident #55 was alert and oriented and able to verbalize needs, but not aware of how he/she sustained the bruise. The resident's medical doctor (MD) and family were notified of the incident. [...]

Inspectors wroteBased on observation, interview, record review and review of pertinent facility documents, it was determined that the facility failed to thoroughly investigate a bruise of unknown origin on 12/6/22. This deficient practice was identified for 1 of 13 residents (Resident #55) reviewed for abuse and was evidenced by the following: On 4/24/2023 at 12:25 PM, a review of Resident #55's Incident/Accident report dated 12/06/2022, revealed that on 12/06/2022 at 06:50 PM, the resident was noted to have a purplish discoloration below the left eye, on the eye bag area, medial side. No skin opening, surrounding skin intact; no swelling noted. The incident report indicated that Resident #55 was alert and oriented and able to verbalize needs, but not aware of how he/she sustained the bruise. The resident's medical doctor (MD) and family were notified of the incident. [...]

Inspectors wroteBased on observation, interview, record review, and review of facility documentation, it was determined that the facility failed to a.) ensure a treatment was administered in accordance with a physician order and in accordance with professional standards of practice, and b.) accurately document skin assessments. This deficient practice was identified for 1 of 2 residents (Resident #1) reviewed for wound care. The 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 interview, record review, and review of other pertinent facility documentation, it was determined that the facility failed to ensure the Consultant Pharmacist (CP) identified and reported irregularities in the resident's medical record to the facility staff and attending physician. This deficient practice was identified for one (1) of twenty-five (25) residents reviewed, (Resident #76) for medication management and was evidenced by the following: On 4/17/22 at 11:20 AM, the surveyor observed Resident #76 in the room and seated in a wheelchair watching television. The surveyor reviewed Resident #76's medical records. A review of the admission Record (an admission summary) reflected that the resident was admitted to the facility with diagnoses which included but not limited to; [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to a). properly label, store, and dispose of medications in 1 (one) of 5 (five) medication carts and 1 (one) of 3 (three) medication room refrigerators inspected and b). failed to properly secure medications in 2 (two) of 4 (four) emergency crash carts inspected. This deficient practice was evidenced by the following: 1. On 4/26/23 at 9:35 AM, the surveyor inspected the [NAME] unit medication cart in the presence of a Registered Nurse (RN#1). The surveyor observed an opened and undated bottle of Pro-Stat solution (a protein supplement). The surveyor interviewed RN#1 who stated that an opened bottle of Pro-Stat solution once opened should have been dated because once opened it only had a 90-day expiration date. [...]

Inspectors wroteBased on observation, interview, and record review it was determined that the facility failed to ensure a contracted staff donned (put on) the appropriate Personal Protective Equipment (PPE) prior to entering a transmissions-based precaution (TBP) room for contact precautions. This deficient practice was identified for 1 of 4 residents on TBP on 1 of 4 units, and b.) disinfect a multi-use wrist blood pressure (BP) cuff in between resident use. This deficient practice was identified for 3 of 6 unsampled residents during a medication administration observation. The evidence was as follows: On 4/20/23 at 6:20 AM, the surveyor observed room [ROOM NUMBER] with a yellow paper that had red Stop sign and PPE: Contact Precaution sign affixed to the outside of the a white PPE bin hung on the outside of the door. The sign revealed: Hand Hygiene, Wear Gloves, and Wear Gown. [...]

Inspectors wroteBased on interview, record review and review of pertinent facility documents, it was determined that the facility failed to attempt to verify information on a newly hired Certified Nursing Aide (CNA) with Reciprocity qualification status in the multi-state registry. This deficient practice was identified for 1 of 5 newly hired staff in the last four months (CNA #1). On [DATE] at 9 AM, the surveyor reviewed five randomly selected newly hired employees in the last four months. The following was revealed: A review of the employee file for CNA #1 revealed a hire date of [DATE]. A review of the New Jersey Department of Health (NJDOH) Online Public Registry verification revealed that CNA #1 had an active certification in New Jersey but had received it based on a qualifying basis of Reciprocity. The Original Issue Date was [DATE]. [...]