Greenwood House Home for the Jewish Aged

Inspectors wroteBased on observations, interviews, and policy review, the facility failed to ensure kitchen utensils were stored in a clean and sanitary manner. These failures had the potential to cause food-borne illness for 101 out of 106 residents who received meals prepared in the facility (five residents received nutrition via feeding tubes).

Inspectors wroteBased on observations, interviews, and facility policy review, the facility failed to ensure staff performed appropriate hand hygiene when moving between rooms, including one with enhanced barrier precautions (EBP), creating a risk for cross-contamination. Additionally, the facility failed to process laundry in a clean and sanitary manner and did not ensure laundry staff consistently washed their hands. This failure has the potential to spread infection among the facility's 106 residents.

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to ensure that food was served at the correct temperature for two residents who received hamburgers (Residents (R) 19 and 90) and food served was palatable in taste for two residents (R 70 and R135). Specifically, the facility did not ensure that dietary staff followed appropriate processes to prepare and serve food palatable for 101 out of census of 106 residents during meal service. This failure had the potential to place residents at increased risk for meal dissatisfaction and the service of potentially unsafe food.

Inspectors wroteBased on record review, interview, and document review, the facility failed to provide residents and their resident representatives (RR) with the required written transfer notice following emergent hospital transfers for two of three residents (Resident (R) 129, and R138) reviewed for hospitalization out of 27 sampled residents. This failure created a risk that residents and their RRs would be uninformed about the reason and location of the transfer and their right to appeal it, if desired.

Inspectors wroteBased on record review, interviews, and review of the Resident Assessment Instrument (RAI) Manual, the facility failed to ensure that one resident of 60 residents (Resident (R) 18) reviewed for missing Minimum Data Set (MDS) assessments over 120 days old had a tracking discharge assessment completed and transmitted in a timely manner. Failure to complete and transmit MDS data timely can lead to inaccurate federal reimbursement and quality measures.

Inspectors wroteBased on record review, interview, and policy review, the facility failed to ensure that a comprehensive Minimum Data Set (MDS) assessment was submitted accurately for one resident (Resident (R) 83) reviewed for MDS assessments out of a total sample of 27 residents. This had the potential to affect quality measures and the resident's care planning process.

Inspectors wroteBased on observation, interview, record review, and policy review, the facility failed to ensure residents did not have side rails on beds when they had not been assessed for their use for one of four residents (Resident (R) 139) reviewed for side rails out of a total of 27 sampled residents. The lack of appropriate assessment placed residents at risk for unintended restraint and potential side rail entrapment.

Inspectors wroteBased on record review, staff interview, and policy review, the facility failed to maintain accurate resident medical records, including physician orders and medication administration records (MARs), for one (Resident (R) 132) of five residents reviewed for medication administration and accuracy of medical records. R132 had a duplicate physician order for the same medication, which was transcribed as two separate entries on the resident's MAR. This documentation error created the potential for the medication to be administered more than once as prescribed, placing the resident at risk for medication errors and possible adverse health effects.

Inspectors wroteBased on observation, interview, and review of pertinent facility documents, it was determined that the facility failed to serve all residents a nourishing snack when there was more than a fourteen-hour span of time between the dinner and breakfast mealtimes. This deficient practice was identified for 3 of 3 residents sampled for bedtime snacks (Resident #29, Resident #46, and Resident #65), and was evidenced by the following: A review of the facility's Nourishment Between Meals policy dated reviewed/revised August 2024, included nursing staff are responsible for offering each resident and afternoon and evening snack to the extent medically possible . During initial tour of the kitchen on 8/5/24 at 9:31 AM, the surveyor accompanied by the Dietary General Manager (DGM) observed half sandwiches on a tray in the walk-in refrigerator. [...]

Inspectors wroteBased on observation, interview, and review of pertinent facility documents, it was determined that the facility failed to store the resident's urinary drainage bag in a dignified manner. This deficient practice was identified for 1 of 2 residents reviewed for urinary catheter (Resident #15), and was evidenced by the following: A review of the facility's Catheter Care - Foley policy, dated revised August 2024, did not include covering the foley catheter bag with a privacy cover. On 8/5/24 at 10:45 AM, during initial tour of the facility, the surveyor observed Resident #15 in their bedroom sitting in a wheelchair. Resident #15 stated that they had a suprapubic (SP) catheter (flexible tube that is inserted into the bladder through the abdominal wall to drain urine) and wore a leg bag during the day. [...]

Inspectors wroteBased on interviews, review of facility policy, and review of pertinent facility documents, it was determined that the facility failed to implement their abuse policy by completing a criminal background check prior to the start of employment. This deficient practice was identified for 1 of 10 employee files reviewed (Employee #4) and was evidenced by the following: A review of the facility's Abuse Policy dated January 2024, included . A. Screening Components Abuse Policy Requirements: It is the policy of this facility to screen employees and volunteers prior to working with residents. Screening components include verification of references, certification and verification of license and criminal background check . On 8/8/24 at 12:00 PM, the surveyor reviewed Employee #4's employment file which revealed the following: Employee #4, a physical therapist (PT), was hired on 9/6/23. [...]

Inspectors wroteBased on observation, interview, and review of pertinent facility documents, it was determined that the facility failed to a.) ensure the plan of care was updated and interventions were implemented to reduce hazards and risks for a resident with a high risk of injury during dining who burned themself with soup (Resident #37); and b.) implement the facility's smoking policy and procedure for a resident who smoked (Resident #84). This deficient practice was identified for 2 of 5 residents reviewed for accidents and hazards (Resident #37 and Resident #84), and was evidenced by the following: 1. [...]

Inspectors wroteBased on observation, interview, and review of pertinent facility documents, it was determined that the facility failed to a.) ensure respiratory equipment was stored and dated in accordance with professional standards when not in use, and b.) ensure an individualized comprehensive care plan included oxygen therapy. This deficient practice was identified for 2 of 2 residents reviewed for respiratory care (Resident #101 and #319), and the evidence was as follows: A review of the facility's Oxygen Administration policy dated revised January 2024, included date the humidifier when put into use .a plastic zip-lock bag is to be attached to the side of the concentrator so the nasal cannula or oxygen mask can be stored there when not in use . [...]

Inspectors wroteBased on observation, interview, and review of pertinent facility documents, it was determined that the facility failed to maintain a system of record keeping that ensures an accurate inventory of controlled medications. This deficient practice was identified on 3 of 7 medication carts reviewed and was evidenced by the following: A review of facility's Controlled Substances policy dated January 2024, included all scheduled II, II, IV and V controlled substances are to be stored under double locks, separate from all other medications. Schedule II through V are counted by incoming and outgoing nurses each shift and signatures documented . On 8/7/24 at 10:28 AM, during medication storage observation, the surveyor, in the of the Licensed Practical Nurse (LPN #1), observed the controlled substances inventory and count logs for the B Wing North nursing unit's medication. [...]

Inspectors wroteBased on observation, interview, and review of pertinent facility records, it was determined that the facility failed to implement infection control protocols for residents on enhanced barrier precautions to prevent the spread of infection. This practice was identified for 1 of 3 residents observed on enhanced barrier precautions (Resident# 87), and was evidenced by the following: A review of the facility's Enhanced Barrier Precautions (EBP) policy dated revised August 2024, included enhanced barrier precautions (EBP) will be used in conjunction with standard precautions by implementing the expanded use of personal protective equipment [PPE] to the donning of gowns and gloves during high contact resident care activities for residents who have an indwelling medical device (urinary catheter, feeding tube etc.) wound or known to be colonized (no active infection) with an organism. [...]

Inspectors wrotePART A NJ Complaint #: 174306 Based on interview and review of pertinent facility documents, it was determined that the facility failed to follow their abuse policies and procedures by ensuring a resident (Resident #171) was free from verbal abuse and an involuntary restraint by: a.) immediately suspending the Registered Nurse (RN #1) and Certified Nursing Aide (CNA #1) who the allegation was made against pending a thorough investigation; and b.) thoroughly investigating an allegation of verbal abuse and involuntary restraint. This deficient practice was identified for 1 of 5 residents (Resident # 171); and two staff members (RN #1 and CNA #1) who had access to all the residents in the facility on 3 of 3 nursing units, reviewed for abuse. [...]

Inspectors wroteNJ Complaint #: 174306 Based on interview and review of pertinent facility documents, it was determined that the facility failed to thoroughly investigate an allegation of verbal abuse and involuntary restraint for a resident (Resident #171) who informed the facility that the Registered Nurse (RN #1) and Certified Nursing Aide (CNA #1) verbally abused them and placed a chair on the side of their bed preventing the resident from using the restroom. This deficient practice was identified for 1 of 5 residents (Resident # 171); and two staff members (RN #1 and CNA #1) who had access to all the residents in the facility on 3 of 3 nursing units, reviewed for abuse. Resident #171, who had diagnoses which included arthritis, anxiety, and depression reported to the Social Worker (SW) on 6/3/24, that two nurses were extremely rude to the resident on the 11:00 PM to 7:00 AM (11-7) shift; [...]

Inspectors wroteComplaint NJ #: 166488 Based on interview, review of the closed medical record, and pertinent facility documents, it was determined that the facility failed to notify a resident's family after a change of condition. This deficient practice was identified for 1 of 31 sampled residents (Resident #170), and was evidenced by the following: A review of the facility's Notification of Changes policy, dated revised July 2021, included it is the policy of [the facility] to notify the resident, resident representative(s) and resident's physician (when applicable) of any changes in a manner to acknowledge and respect the resident's rights .[the facility] will immediately inform the resident, consult the resident's physician, and notify, consistent with his/her authority, the resident representative(s) when there is: A significant change in the resident's physical, mental or psychological status (i. [...]

Inspectors wroteCOMPLAINT#: NJ00171710 Based on observations, interviews, medical records review, and review of other pertinent facility documentation on 03/07/24 and 03/08/2024, it was determined that the facility failed to report within the required timeframe an incident involving an alleged abuse allegation to the New Jersey Department of Health (NJDOH) and b.) follow the facility's Abuse Policy. The alleged violation was reported to staff regarding an incident that involved a resident that was found to have a discoloration on the left arm. When the resident was asked how that happened, the resident said that a staff member had grabbed the arm. This deficient practice was identified for 1 of 4 sampled residents (Resident #1) and was evidenced by the following: During a tour of the unit on 03/07/24 at 10:36 a.m., the surveyor knocked on Resident #1's door and was granted entry by the resident. [...]

Inspectors wroteBased on observation, interview, record review, and review of other pertinent facility documents, it was determined that the facility failed to ensure informed consent was obtained, an assessment was completed, and inspections were completed for side rails. The deficient practice was identified for 1 of 2 residents (Resident #72) reviewed for side rails and was evidenced by the following: On 11/29/22 at 11:03 AM, the surveyor observed Resident #72 in bed with his/her eyes open. The surveyor observed the resident's bed had two half-length side rails in the up position on both upper sides of the bed. On 12/2/22 at 12:00 PM, the surveyor observed Resident#72 out of bed sitting in a geri chair (an adaptive chair) in the hallway just outside of his/her room. At that time, the surveyor observed two half side rails in the up position on both upper sides of the resident's bed. [...]

Inspectors wroteBased on observation, interview, and record review it was determined the facility failed to accurately document the administration of controlled medication for an unsampled resident. This deficient practice was identified on 1 of 5 medication carts (North A-Wing) reviewed and evidenced by the following: On 12/5/22 at 9:49 AM, the surveyor in the presence of the Registered Nurse (RN) inspected North A-Wing medication cart. The surveyor in the presence of the RN reviewed the narcotic medication located in the secured and locked narcotic box. When the narcotic medication inventory was compared to the declining inventory sheet, the surveyor identified an unsampled resident's pregabalin 150 milligram (mg) capsules, a medication used for anxiety, epilepsy and nerve pain, did not match. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to a.) maintain a refrigerator temperature log to ensure medications were stored at appropriate temperature and b.) properly label and date medications in accordance with manufacturer recommendations. This deficient practice was observed in 1 of 2 medication (C-West) storage rooms and 1 of 5 medication carts (C-West) inspected and was evidenced by the following: 1. On 12/5/22 at 10:16 AM, the surveyor in the presence of the Registered Nurse/Unit Manager (RN/UM) inspected the C-West medication cart. The surveyor observed an opened and undated insulin lispro syringe in active inventory. The RN/UM stated the pen was supposed to be dated when it was opened. The RN/UM acknowledged the pen did not have an opened date or expiration date indicated on the pen. [...]

Inspectors wroteBased on observation, interview, and review of pertinent facility documentation, it was determined that the facility failed to a.) handle potentially hazardous foods and maintain sanitation in a safe, consistent manner designed to prevent foodborne illness and b.) maintain kitchen equipment in a manner to prevent microbial growth. This deficient practice was evidenced by the following: On 11/29/22 at 9:28 AM, the surveyor toured the kitchen with the Director of Dietary (DD) and observed the following: In the walk-in refrigerator: 1. One five-pound container of sour cream with an expiration date of 11/22/22. The DD confirmed it needed to be discarded. 2. One opened cottage cheese container with an expiration date of 1/2/23. The container was not labeled the date opened or when to discard. The DD stated that cottage cheese should be discarded three days after it was opened. [...]