Hunterdon Care Center LLC

Inspectors wroteComplaint: 2582599 Based on interview, review of the medical records, and review of other pertinent facility documents, it was determined that the facility failed to ensure a safe discharge for a resident (Resident #3) with severe cognitive impairment, who lived in the community alone, and was denied at home nursing care services upon discharge. This deficient practice was identified for 1 of 4 residents reviewed (Resident #3). Resident #3, who was had a Brief Interview for Mental Status (BIMS) score of 5 out of 15, indicating a severely impaired cognition with an admission diagnosis of cognitive impairment, was discharged from Medicare Part A services with a last date of coverage on [DATE]. Resident #3 lost an appeal and was discharged to the community on [DATE]. [...]

Inspectors wroteComplaint # 2582599Based on interview, review of the medical records, and review of other pertinent facility documents, it was determined that the facility failed to ensure a discharge summary was written at the time a resident (Resident #3) was discharged from the facility. This deficient practice was identified for 1 of 4 residents reviewed (Resident #3). The surveyor reviewed the closed medical record for Resident #3. According to the admission Record (AR) face sheet, Resident #3 was admitted to the facility with diagnoses which included but were not limited to: mild cognitive impairment, enterocolitis due to clostridium difficile (C. diff; [...]

Inspectors wroteBased on interview and review of pertinent documentation provided by the facility, it was determined that the facility failed to implement the facility's abuse policy to ensure that reference checks were completed for 10 of 10 employee files reviewed. This deficient practice was evidenced by the following: On 3/18/25 at 9:30 AM, the surveyor reviewed 10 randomly selected employee files, which revealed the following: 1. Licensed Practical Nurse/Unit Manager (LPN/UM) #3, with a hire date of 1/22/24, did not have a previous employee reference on file. 2. Licensed Practical Nurse (LPN) #2, with a hire date of 11/25/24, did not have a previous employee reference on file. 3. Certified Nursing Assistant (CNA) #2, with a hire date of 1/25/25, did not have a previous employee reference on file. 4. [...]

Inspectors wroteBased on observation, interview, record review, and review of facility documents, it was determined that the facility failed to honor a resident's choice to a.) get out of bed at the resident's preferred time and b.) attend preferred activities for 1 of 1 resident (Resident #79) reviewed for choices. This deficient practice was evidence by the following: On 3/13/25 at 9:43 AM, the surveyor observed Resident #79 lying in bed. The resident stated he/she preferred to be out of bed by 9:30 AM every morning. The resident further stated that there was a Coffee Social activity scheduled for 10:30 AM in the dining room that they wanted to attend. When asked about the resident's usual get up time, the resident stated that staff normally get them up around 11:00 AM which meant they missed their preferred activities. [...]

Inspectors wroteComplaint #NJ #00172794 Based on interview, record review, and review of other facility documentation, it was determined that the facility failed to submit the facility investigation to the New Jersey Department of Health (NJDOH) within five (5) days, specifically when a resident sustained a fracture of unknown origin for 1 of 2 residents (Resident #53) reviewed for abuse. This deficient practice was evidenced by the following: A review of the admission Record, an admission summary, revealed the resident had diagnoses which included: dementia, history of traumatic fracture, and polyarthritis (a condition characterized by inflammation and pain in multiple joints). [...]

Inspectors wroteComplaint #NJ00172794 Based on interviews, record review, and review of facility documents, it was determined that the facility failed to conduct a thorough investigation for a resident who sustained a significant injury of unknown origin. This deficient practice was identified for 1 of 2 residents (Resident #53) reviewed for abuse, and was evidenced by the following: On 3/17/25 at 10:30 AM, the surveyor reviewed Resident #53's electronic medical record (EMR). A review of the admission Record, an admission summary, revealed the resident had diagnoses which included: dementia, history of traumatic fracture, and polyarthritis (a condition characterized by inflammation and pain in multiple joints). [...]

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 34 residents (Resident #121) reviewed for MDS coding accuracy. This deficient practice was evidenced by the following: On 3/17/25 at 9:15 AM, the surveyor reviewed the electronic medical record (EMR) of Resident #121. A review of the admission Record, an admission summary, revealed that Resident #121 had diagnoses that included, but were not limited to, heart failure, depression, and anxiety disorder. [...]

Inspectors wroteBased on interviews and review of pertinent facility documents, it was determined that the facility failed to provide pharmaceutical services in accordance with professional standards to ensure accurate documentation of the receipt of a controlled substance for three (3) of six (6) Schedule II controlled substance medications ordered and received by the facility for use as an emergency backup supply, on two (2) Drug Enforcement Agency (DEA) 222 Forms (a form used to order controlled substances from a provider) reviewed. The deficient practice was evidenced by the following: Reference: 21 CFR 1305.13 Procedure for filling DEA Forms 222. 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 documentation, it was determined that the facility failed to ensure that the resident did not receive an unnecessary medication for one (1) of five (5) residents reviewed for unnecessary medications. (Resident #74). The deficient practice was evidenced by the following: The surveyor reviewed Resident #74's electronic medical record (EMR) which revealed the following. A review of the admission Record (AR, an admission summary), reflected that the resident was admitted to the facility with diagnoses which included, diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods) and diastolic congestive heart failure, (a condition that occurs when the heart muscle can't pump blood efficiently). [...]

Inspectors wroteBased on observation, interview, and review of pertinent facility documents, it was determined that the facility failed to follow appropriate infection control and sanitary practices for storing medical devices and equipment while not in use. This deficient practice was identified in one (1) of three (3) observations during the Medication Pass observation (med-pass). This deficient practice was evidenced by the following: On 3/17/25 at 9:00 AM, the surveyor observed medication being administered to Resident #91. The surveyor then observed an oxygen mask, tubing and a nebulizer machine (a device used administer liquid medications by inhalation) on the floor at the foot of the bed of Resident #9, the roommate of Resident #91. The mask, tubing and machine were not observed to be in a bag or other container. [...]

Inspectors wroteBased on observations and interviews on 3/13/2025 and 3/14/2025, in the presence of the Director of Maintenance (DOM), it was determined that the facility failed to ensure that all devices used to identify call bell notifications were properly functioning. This deficient practice had the potential to affect 6 of 170 residents and was evidenced by the following: An observation on 3/13/2025 at 12:22 PM, revealed that the call bell for resident room C-113 did not give audible notification of activation at the nurse's station when tested by the DOM. An observation at 12:25 PM, revealed that the call bell for resident room C-117 did not give audible notification of activation at the nurse's station when tested by the DOM. [...]

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure proper hand hygiene procedures were followed to potentially prevent the development and transmission of communicable diseases for four of four dining observations involving residents (Resident (R) 18, R137, R99, and R107) on the locked dementia unit. This had the potential to affect all 31 residents who reside on the locked dementia care unit.

Inspectors wroteBased on observations, interview, record review, and policy review, the facility failed to ensure that the unit nourishment rooms refrigerators and ice machines were maintained to prevent potential foodborne illness. The facility identified a census of 163 residents at the time of the survey.

Inspectors wroteBased on observations, interviews, record review, and facility policy review, the facility failed to honor a resident's choice of a shower over bed baths for one resident (Residents (R) 67) of one resident reviewed for choices out of a total sample of 32 residents.

Inspectors wroteBased on interview and record review, the facility failed to ensure the resident assessment accurately reflected the resident's hospice designation for one (Resident (R) 20) of one resident sampled for hospice out of a total sample of 32 residents. This failure could result in the residents' needs, strengths, and areas of decline not being addressed.

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to ensure one of two residents (Residents (R) 76) reviewed out of a total sample of 32 had completed a Pre-admission Screening and Resident Review (PASARR) upon receipt of a new mental health diagnoses. This failure placed resident at risk for unmet care needs and for not receiving appropriate mental health support/services needed.

Inspectors wroteBased on observations, interviews, record review, and policy review, the facility failed to ensure that a resident received consistent range of motion exercises for one (Residents (R) 125) of one resident reviewed for range of motion out of a total sample of 32 residents.

Inspectors wroteBased on interviews, record review, and policy review, the facility failed to ensure two of five residents (Resident (R) 119 and R152) who received psychoactive medications, and reviewed for unnecessary medications, had monitoring for efficacy for the target symptoms (reasons for use) for the medication. This failure had the potential to keep residents from receiving the lowest possible effective psychoactive medication dose.

Inspectors wroteBased on record review, interview, and facility policy review, the facility failed to ensure that one of one resident (Resident (R) 84) record reviewed for wound documentation out of a total sample of 32 residents reflected the visualized facial wounds. This failure had the potential to create incorrect assessments, care planning, or worsening of the wounds due to the lack of monitoring.

Inspectors wroteBased on interview, record review, and policy review, the facility failed to ensure the appropriate coordination of hospice care by specifically failing to maintain hospice orders, care plan, and a hospice election form for one (Resident (R) 20) of one resident sampled for hospice out of a total sample of 32 residents. This failure had the potential result in the interruption of the resident's coordination of care.

Inspectors wroteBased on observation, interview and record review, it was determined that the facility failed to ensure that an expired glucose medication (Glutose 15 gel) was removed from the active inventory stored in the medication cart from April 2020 to October 2020. This deficient practice was identified for 1 of 4 medication carts (Spruce Unit) that were inspected and was evidenced by the following: On 10/7/20 at 10:54 AM, the surveyor inspected the Spruce Unit medication cart with the Registered Nurse (RN) in the presence of another surveyor. The top drawer contained four (4) tubes of Glutose 15 gel (an oral glucose gel medication used to raise the blood glucose level when it becomes dangerously low). The surveyor observed that 3 of 4 available glucose gel tubes in the medication cart had an expiration date of 4/2020. [...]

Inspectors wroteBased on observation, interview, record review and review of pertinent facility documentation, it was determined that the facility failed to develop a comprehensive care plan for a resident with dementia and on psychotropic medications. This deficient practice was identified for 1 of 30 residents (Resident #135) reviewed for comprehensive care plans. On 10/1/2020 at 11:12 AM, the surveyor observed Resident #135 reclined in a gerichair in the hallway near the nursing station. The resident was wearing a surgical mask. The surveyor observed the resident repeatedly stating, cover me even after a staff member covered the resident with blankets. The surveyor reviewed the medical record for Resident #135. A review of the admission Record face sheet (an admission summary) reflected that the resident had been admitted to the facility with diagnoses which included but were not limited to; [...]

Inspectors wroteBased on observation, interview, record review, and review of pertinent facility documentation, it was determined that the facility failed to communicate and document the physician's response to Wound Consultant recommendations in accordance with professional standards of nursing practice. This deficient practice was identified for 1 of 3 residents reviewed with pressure ulcers (Resident #146). The evidence was as follows: Reference: New Jersey Statues, Annotated Title 45, Chapter. 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 ensure: a.) a pressure ulcer was cleansed upon direct contact with linens and b.) hand hygiene was performed between glove changes during the wound treatment observation. This deficient practice was identified for 1 of 3 residents reviewed for pressure ulcers (Resident #146). The evidence was as followed: On 9/30/2020 at 11:15 AM, the surveyor observed Resident #146 lying in bed on an air mattress. The resident had a pillow positioned under his/her right side. The surveyor attempted to interview the resident at that time, but the resident was unsure if he/she had any wounds. On 10/5/2020 at 10:20 AM, the surveyor interviewed the Licensed Practical Nurse (LPN) who stated that Resident #146 had a pressure ulcer to the sacrum with slough (yellowing dead tissue). [...]