Pine Acres Rehabilitation and Healthcare

Inspectors wroteBased on observation, interview, and review of facility policies, it was determined that the facility failed to maintain proper kitchen sanitation practices in a manner to prevent food borne illness. On 1/11/26 at 9:28 AM, the surveyor in the presence of the Food Service Director (FSD) observed the following during the kitchen tour:1. In the three-door standing freezer, the surveyor observed an open bag of French Fries, vegetable burgers, all-beef hamburger and shrimp; all missing open and use-by labels. The FSD stated all items that have been opened should have open and use-by dates.2. In the ice cream freezer, the surveyor did not observe a thermometer. The FSD stated they would put a new thermometer in the freezer immediately. 3. In the beverage preparation area, the surveyor observed the juice dispenser with 4 of 7 tubes noted with a sticky build up on the tubing. [...]

Inspectors wroteComplaint # 2707766 Based on observation, interview, record review, and review of facility-provided documentation, it was determined that the facility failed to ensure that incontinence care was provided to dependent residents in a timely manner for 6 of 6 residents (Resident #1, #13, #16, #41, #68 and #83) observed for incontinence care on 1 of 3 units (First floor nursing unit). This deficient practice was evidenced by the following: 1. On 1/11/26 at10:39 AM, the surveyor was touring the 1st floor unit and smelled a strong odor of urine throughout the unit. On 1/11/26 at 11:15 AM, the surveyor interviewed Resident #1, who was sitting in their wheelchair next to their bed. The surveyor observed an adult brief laying on the top of the Resident #1's bed that was statured with urine. [...]

Inspectors wroteBased on observation, interview, and review of facility policy, it was determined that the facility failed to provide a homelike environment in resident rooms. The deficient practice was observed in 1 of 3 units during the initial tour. The deficient practice was evidenced by the following:On 01/13 /2026 at 10:00 AM, the surveyor toured the 1st floor nursing unit and observed the following:1. In room [ROOM NUMBER], the heater cover in the bathroom was broken. The surveyor also observed that the wall behind the door bed had chipped paint, exposing the wallboard, and the wall by the window bed had chipped paint across the entire wall, exposing the wallboard.2. In the shower room, there were broken floor tiles and a broken toilet seat. The shower mat was heavily soiled, and the floor beneath it was covered in a thick brown substance. [...]

Inspectors wroteBased on observation, interview, record review, and review of facility policies it was determined that the facility failed to provide safety measures, nursing orders and follow interventions for a resident who has a history of falls. This deficient practice was identified for 3 of 3 residents (Resident #3, #5, and #66) reviewed for falls. The deficient practice was evidenced by the following: 1. On 1/11/26 at 10:55 AM, the surveyor observed Resident #3 in their room sitting in a medical reclining chair with a call bell in hand. Resident #3 was unable to participate in an interview related cognition. On 1/11/26 at 11:30 AM, the surveyor reviewed the hybrid medical record (combination of the electronic medical record (e-MAR) and the physical medical chart). [...]

Inspectors wroteBased on observation, interview, record review, and review of pertinent facility documents, it was determined that the facility failed to administer Oxygen Therapy according to the physician's order for 1 of 3 Residents (Resident # 83), reviewed for respiratory therapy. This 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: 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 wroteComplaint # 2707766 Based on observation, interview, and review of pertinent facility documentation, it was determined the facility failed to ensure that sufficient and competent staff were available to provide appropriate incontinence care to dependent residents for 5 of 6 residents (Resident #13, #16, #41, #68 and #83) on 1 of 3 units (1st -floor Nursing Unit). This deficient practice was evidenced by the following: Refer to F6771. On 1/13/2026 at 7:25 AM, during an interview with the surveyor, the Licensed Practical Nurse/ Unit Manager (LPN/UM) identified residents as being incontinent and dependent on staff for care. On 1/13/26 at 7:30 AM, the surveyor conducted an incontinence tour on the 1st floor East Nursing Unit and observed the following: a. On 1/13/26 at 7:30 AM, the surveyor accompanied by the LPN/UM observed Resident #13 in bed. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to develop and implement a person-centered comprehensive care plan (CP) to meet the resident's needs. This deficient practice was observed for 2 of 19 residents reviewed, Resident #30 and #15, as evidenced by the following: 1. On 08/26/24 at 08:22 AM, the surveyor observed Resident #30 in the dining room eating, using their left hand. The resident stated to the surveyor that their right hand was weak. The resident further stated that the facility provided something for their right hand, but they refused to wear it. On 08/27/24 at 10:05 AM, the surveyor interviewed the Certified Nurse Assistant #2 (CNA#2) who was assigned to Resident #30. CNA #2 stated the resident used the left arm most of the time due to the weakness of the right arm. [...]

Inspectors wroteBased on observation, interview, and review of medical records, it was determined that the facility failed to a.) follow appropriate hand hygiene practices to prevent the potential spread of infection observed during care for Resident #15 and b.) provide urinary care in a sanitary manner for 1 of 2 for Resident #59. This deficient practice was evidenced by the following: According to the CDC Clinical Safety: Hand Hygiene for Healthcare Workers dated 02/27/24 revealed: Healthcare personnel should use an alcohol-based hand rub (ABHR) or wash with soap and water for the following clinical indications: Immediately before touching a patient . Before moving from work on a soiled body site to a clean body site for the same patient, After touching a patient or the patient's immediate environment After contact with blood, body fluids, or contaminated surfaces Immediately after glove removal. [...]

Inspectors wroteBased on observation, interview, and review of pertinent facility documents it was determined that the facility failed to notify CMS (Centers for Medicare & Medicaid Services) and receive authorization for a change in facility name in accordance with 42 CFR (Code of Federal Regulations) 424.516. This deficient practice was evidenced by the following: According to 42 CFR 424.516 Additional provider and supplier requirements for enrolling and maintaining active enrollment status in the Medicare Program: (a) Certifying compliance. CMS enrolls and maintains an active enrollment status for a provider or supplier when that provider or supplier certifies that it meets, and continues to meet, and CMS verifies that it meets, and continues to meet, all of the following requirements: (1) Compliance with title XVIII of the Act and applicable Medicare regulations. [...]

Inspectors wroteBased on the interview and record review, it was determined that the facility failed to accurately complete the Minimum Data Set (MDS), an assessment tool used to facilitate the management of care, in accordance with the federal guidelines for 1 of 19 residents (Resident #75) reviewed for the accuracy of MDS completion. The deficient practice was evidenced by the following: On 08/26/24, at 09:05 AM, the surveyor observed Resident #75 seated in bed eating their meal. On 08/27/24 at 12:54 PM, the surveyor reviewed Resident #75's electronic medical record, which revealed the following information: According to the admission Record (an admission summary), Resident #75 was admitted to the facility with diagnoses that included but were not limited to unspecified Dementia (loss of memory) and other behavioral disturbances. [...]

Inspectors wroteBased on observations, interviews, record review, and policy review, the facility failed to ensure staff followed sanitation procedures for the sanitizing of dishware through the dishwasher and failed to label and date residents' food and monitor the freezer temperatures for the residents' refrigerators located at the nursing stations. These failures had the potential for 86 out of 89 residents to be at risk for food-borne illness (three residents received nutrition via feeding tubes).

Inspectors wroteBased on observation and interview, the facility failed to ensure the dumpster area was maintained in a sanitary manner on two of two days in which a significant amount of garbage was on the ground around the dumpster creating the potential for harborage of pests.