Seacrest Rehabilitation and Healthcare Center

Inspectors wroteBased on observation, interviews, and record review, it was determined that the facility failed to maintain food service and hydration station equipment in a clean and sanitary manner. This deficient practice was evidenced by the following:On 12/15/25 at 9:35 AM, during a tour of the kitchen with the Food Service Director (FSD), the surveyor observed the following:The top of the steamer was visibly soiled with food debris and splashes. The FSD acknowledged the finding and stated that, per facility policy, the steamer top should be cleaned when visibly soiled. The gas oven was observed with splashes of grease and burnt food particles on interior surfaces. [...]

Inspectors wroteBased on interview, record review, and review of pertinent facility documents it was determined that the facility failed to accurately code the Minimum Data Set (MDS), an assessment tool used to guide the planning and management of care for all residents. This deficient practice was identified for 1 of 19 residents (Resident #9) reviewed for MDS accuracy and was evidenced by the following:A review of the admission Record (admission summary) reflected that Resident #9 was admitted to the facility with the diagnoses which included but was not limited to; depression and schizoaffective disorder (a serious mental illness blending symptoms of schizophrenia (hallucinations, delusions, disorganized thinking) with those of a mood disorder (depression or mania), where psychotic symptoms occur even without mood episodes)). A review of the quarterly Minimum Data Set (MDS; [...]

Inspectors wroteBased on observation, interview, and record review it was determined that the facility failed to initiate an individualized care plan (ICP) for residents a.) that was incontinent of bladder and bowel and b.) identified with contractures (a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity or rigidity of joints) and limited range of motion (ROM). This deficient practice was identified for 2 (two) of 30 residents (Resident #14 and #126) reviewed for comprehensive Individual Care Planning (ICP) and implementation and was evidenced by the following: 1. On 12/15/2025 at 09:40 AM during initial tour of the facility the surveyor observed Resident # 95 in bed and they asked if surveyor # 1 could find someone to change his/her brief. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to ensure that 1.) Physician-ordered treatments were administered as scheduled and 2.) proper hand hygiene and infection control practices were maintained during wound care. This deficient practice was identified for 1 of 1 resident (Resident # 22) reviewed for wound care and skin integrity. The deficient practice was evidenced by the following:A review of the Electronic Medical Record (EMR) for Resident # 22 revealed a physician's order dated 11/24/2025 for wound care to clean skin tears on bilateral arms with wound cleanser and apply xeroform and an abdominal dressing with Kling wrap daily and PRN (as needed). A review of the admission 5-Day Minimum Data Set (MDS; [...]

Inspectors wroteBased on observation, interview, record review, and review of facility documents, it was determined that the facility failed to a.) obtain physician orders for oxygen (O2) therapy before administering continuous oxygen, b.) monitor and document O2 levels while administering continuous oxygen, and c.) ensure that a resident's Interdisciplinary Care Plan (ICP) accurately reflected and guided the Resident's respiratory care needs in accordance with professional standards of nursing practice. This deficient practice was identified for 1 (one) of 6 residents (Resident #25) reviewed for Oxygen and was evidenced by the following: During the initial tour of the facility on 12/15/2025 at 10:39 AM, the surveyor observed Resident #25 lying in bed in their room. [...]

Inspectors wroteBased on observation, interview, and record review it was determined that the facility failed to ensure a pain management regimen was followed in accordance with physician orders. This deficient practice was identified in 1 of 2 residents reviewed for pain (Resident #12). This deficient practice was evidenced by the following:On 12/15/25 at 11:22 AM, during the initial tour of the facility Resident #12 was observed in the room and said they feel good. On 12/16/2025 at 1:06 PM, Resident #12 was observed in the room and told the surveyor that he/she felt good, that they receive pain medication and said that their pain was controlled. A review of Resident #12's admission Record (an admission summary) reflected that Resident #12 was admitted to the facility with diagnoses which included but were not limited to arthritis and low back pain. [...]

Inspectors wroteBased on interview and record review, it was determined that the facility failed to ensure that medications were administered in accordance with prescriber orders by failing to administer an intravenous (IV) antibiotic within the required timeframe. This deficient practice was identified for 1 of 1 resident (Resident # 3) review for medication administration. The deficient practice was evidenced by the following:A review of Resident # 3's diagnoses revealed but were not limited to, acute osteomyelitis (a sudden and painful infection of the bone) of the left ankle and foot, bacteremia (the presence of harmful bacteria in the bloodstream), and a Methicillin-resistant Staphylococcus aureus (MRSA) infection (a type of staph bacteria that is very difficult to treat because it is resistant to many common antibiotics). [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to ensure that all medications and medical supplied were stored safely, securely, and in accordance with professional standards. The facility failed to ensure that a resident did not self-administer medications without a physician's order, evaluation, and care plan, and failed to store medications in a locked area. Additionally, the facility failed to ensure medical supplies were maintained for use by having expired supplies in 1 of 2 medication storage rooms inspected under the Medication Storage task. The deficient practice was identified for 1 of 1 residents (Resident # 38) reviewed for medication storage and 1 of 2 medication storage rooms inspected. The deficient practice was evidenced by the following: [...]

Inspectors wroteBased on record review, interview, and review of facility documentation, it was determined that the facility failed to ensure that 1 of 24 Registered Nurses (RN # 1) maintained a valid license or multistate privilege to practice in the State of New Jersey in accordance with the Nurse Licensure Compact (NLC) 60-day residency rule. The deficient practice was evidenced by the following: A review of the employee file for RN # 1 revealed that she was hired on 8/14/2025. The file included a New Jersey Driver's License issued on 01/17/2025, which listed a primary residential address in New Jersey. A review of RN # 1's employment application, signed on July 21, 2025, also listed a primary residential address in New Jersey. [...]

Inspectors wroteBased on observation, interview, record review, and review of pertinent facility documents it was determined that the facility staff failed to ensure that respiratory equipment was stored in a manner that prevented contamination, in accordance with infection prevention and control standards for 1 of 6 residents reviewed for oxygen. (Resident # 57). The deficient practice was evidenced by the following: On 12/16/2025 at 09:32 AM during the initial tour the surveyor observed Resident # 57's continuous positive airway pressure (CPAP) machine (a machine that gently blows air throw a hose and mask to help a person breath while they sleep) mask laying on the night stand open to air. [...]

Inspectors wroteComplaint #'s: NJ428767 and NJ428770Based on record review, interviews and document review, the facility failed to protect one of four residents Resident (R) #5 from an accident hazard. Specifically, Certified Nurse Aide (CNA) #1 pushed R5 in a wheelchair without leg rests causing R5's legs to become trapped underneath the wheelchair, which resulted in the fracture of R5's left femur. This failure caused unnecessary pain and resulted in R5 requiring surgery to repair the left femur fracture.

Inspectors wroteComplaint #: NJ2666455Based on interview and policy review, the facility failed to provide educational materials to residents and/or resident representatives so that they could make an informed decision in regard to be administered the Coronavirus Disease (COVID-19) vaccine. This failure had the potential for all 145 residents in the facility who are the vulnerable population to be exposed to and have a greater chance of these residents contracting COVID-19. Interview with Health Department (HD)1 on 11/24/25 at 2:50 PM to discuss the COVID outbreak at the facility. HD1 confirmed during the call that the facility had kept the local Health Department (LHD) updated daily identifying which residents were positive for COVID and whether residents had received the COVID vaccine. During the conversation, it was discussed that the facility had a 9% COVID vaccination rate. [...]

Inspectors wroteComplaint #: NJ428748Based on interview, record review, and review of the facility's policy, the facility failed to ensure nurses completed narcotic mediation counts to maintain accountability for three of four residents' narcotic medications (Resident (R) 7, R8, and R9) out of 13 sampled residents. This failure had the potential for R7, R8, and R9's narcotic medications being diverted.

Inspectors wroteBased on observation, interview, and review of other facility documentation, it was determined that the facility failed to handle potentially hazardous foods and maintain sanitation in a safe and consistent manner to prevent food borne illness. This deficient practice was evidenced by the following: On 7/29/2024 from 09:28 AM to 09:48 AM the surveyor accompanied by the Regional Food Service Director (RFSD), observed the following in the kitchen: 1. In the walk-in refrigerator there was raw fish wrapped in plastic wrap with a use by date of 7/28/2024. The RFSD removed the fish and stated, That should have been removed. 2. In the walk-in freezer there was a bag of frozen pork with a use by date of 7/10/2024 and three bags of frozen corned beef with a use by date of 5/6/2024. The RFSD removed the items and stated, They should have all been removed. 3. [...]

Inspectors wroteBased on observation, interview, record review, and review of pertinent facility documentation, it was determined that the facility failed to identify, document, and transmit on the Minimum Data Set (MDS) an assessment tool used to facility resident care, a resident's diagnosis of skin cancer. This deficient practice was identified for 1 of 27 residents (Resident # 72) reviewed for MDS. This deficient practice was evidenced as follows: On 07/29/2024 at 9:47 AM, the surveyor observed Resident #72 self-propelling in their wheelchair (w/c) around the third-floor unit. The surveyor observed the resident had multiple red sores on their face. On 07/31/2024 at 12:52 PM, the Licensed Practical Nurse (LPN) stated that Resident # 72's sores were skin cancer lesions. The LPN further stated that the resident had this diagnosis and sores for three years. [...]

Inspectors wroteBased on interview, record review, and review of facility documentation, it was determined that the facility failed to complete and transmit a death in facility Minimum Data Set (MDS) an assessment tool, for 1 of 1 resident (Resident # 16) reviewed for MDS record over 120 days old. The deficient practice was evidenced by the following: A review of the admission Record revealed Resident # 16 was admitted with diagnoses which included but were not limited to; hypertension (elevated blood pressure) and atherosclerotic heart disease (a build up of fats in the walls of the arteries causing narrowing). A review of the progress notes revealed a note dated 05/21/2024 at 16:24 (4:24 PM), the resident was noted sitting in their wheelchair and was nonresponsive. The resident was taken to their room and was noted without a pulse and no respirations. [...]

Inspectors wroteBased on observation, interview, record review, and review of pertinent facility documentation it was determined that the facility failed to provide treatment and care to address the resident's positioning needs that were in accordance with professional standards of practice that were based on the comprehensive assessment, person-centered care plan and the resident's choice. The deficient practice was identified for 1 of 4 residents reviewed for Position and Mobility. The deficient practice was evidenced by the following: On 07/29/2024 at 10:30 AM during the initial tour, the surveyor observed Resident # 115 in the hallway in his/her wheelchair. He/she had a white, leg splint observed on his/her left leg. The splint was located outside of his/her pants. On 07/30/2024 at 11:57 AM, the surveyor observed Resident # 115 in the hallway in his/her wheelchair. [...]

Inspectors wroteBased on observation, interview, record review and review of pertinent facility documentation it was determined that the facility failed to provide appropriate and sufficient care based upon current standards of practice and the resident's care plan by specifically having a urinary catheter drainage bag in contact with the floor and unsecured to the bed frame and failing to document urinary outputs on the treatment administration record (TAR) as ordered. The deficient practice was identified for 1 of 1 residents (Resident #73) investigated for Urinary Catheter or UTI (Urinary Tract Infection). The deficient practice was evidenced by the following: A review of Resident # 73's Minimum Data Set, an assessment tool dated 7/12/2024 located in the Electronic Medical Record revealed he/she had an indwelling urinary catheter. [...]

Inspectors wroteBased on observation, interview, record review and review of facility documentation, it was determined that the facility failed to ensure a resident's oxygen delivery system was stored to protect it from the environment. This deficient practice was identified for 1 of 2 residents (Resident #118) reviewed for oxygen use and was evidenced as follows. On 07/29/2024 at 10:29 AM, the surveyor observed Resident #118 in a high back wheelchair (w/c) in the third-floor unit day room. Resident #118 had a portable oxygen tank on the back of the w/c and was wearing a nasal cannula (n/c) as an oxygen delivery system. On 07/30/2024 at 12:49 PM, the surveyor observed Resident #118 again in the third-floor unit day room. Resident #118 was not wearing a n/c. The surveyor observed the back of the w/c with the portable oxygen tank. [...]

Inspectors wroteBased on observation, record review, and review of pertinent facility documentation, it was determined that the facility failed to consistently monitor and document behaviors of residents on psychotropic medications per the physician's orders and the resident-centered Care Plan. This deficient practice was identified for 2 of 7 residents (Resident # 105 and # 117) reviewed for behaviors and was evidenced by the following: 1.) On 07/29/24 at 10:13 AM, the surveyor observed Resident # 105 in the third-floor unit day room. Resident # 105 was holding a blanket; their eyes were closed, and the resident did not respond to the surveyor when the surveyor greeted the resident. On 08/01/24 at 8:12 AM, the Certified Nursing Assistant (CNA) stated she did care for Resident # 105 too often and was not sure of the resident's behaviors. [...]

Inspectors wroteBased on observation, interview, record review, and review of pertinent facility documentation, it was determined that the facility failed to monitor and document potential side effects of psychotropic medications per physician's orders and the resident-centered Care Plan. This deficient practice was identified for 2 of 5 residents (Resident # 105 and # 117) reviewed for unnecessary medications and was evidenced by the following: 1.) On 07/29/24 at 10:13 AM, the surveyor observed Resident # 105 in the third-floor unit day room. Resident # 105 was holding a blanket; their eyes were closed, and the resident did not respond to the surveyor when the surveyor greeted the resident. A review of the admission Record revealed that Resident # 105 was admitted with diagnoses which included but were not limited to; delusional disorders, depression, unspecified mood disorder, and dementia. [...]

Inspectors wroteBased on observation, interview, and review of other facility documentation, it was determined that the facility failed to maintain the kitchen sanitation in a safe and consistent manner to prevent food borne illness. This deficient practice was evidenced by the following: On 11/16/2022 from 9:03 to 9:43 AM the surveyor's, accompanied by the facility Food Service Director (FSD) and Registered Dietitian (RD) observed the following in the kitchen: 1. On a lower shelf, a plastic container contained bags of individually opened pasta. (3) individual bags of opened pasta wrapped in plastic wrap had no open or use by dates. (1) bag of pasta was opened and exposed to the air. On interview the FSD stated They should be labeled with an opened and use by date. 2. [...]

Inspectors wroteBased on observation, interview, and review of other facility documentation, it was determined that the facility failed to ensure that the residents' dining experience was provided in a manner to promote the dignity and respect of the residents, by a) staff not sitting while feeding a resident and b) residents who were not served their meal at the same time while seated at the same table. This deficient practice was observed for 7 of 27 residents reviewed for dining (Resident # 56, Resident #91 and 5 unsampled Residents). This deficient practice was evidenced by the following: On 11/16/2022 at 12:45 PM, during the initial lunch meal observation on the 3rd floor dining room, the surveyor observed the following: 1. A staff member who identified herself as a Registered Nurse (RN) #1, was observed standing over an unsampled resident while assisting him/her to eat. [...]

Inspectors wroteBased on observation, interview, review of the medical record and other facility documentation, it was determined that the facility failed to: a.) obtain a physician's order for a resident to self-administer medication, and b.) periodically assess the resident's ability to safely self-administer medication. This deficient practice was identified for 1 of 27 sampled residents, (Resident #69) and was evidenced by the following: On 11/16/2022 at 10:10 AM, the surveyor observed Resident #69 sitting on the edge of the bed. The surveyor observed an inhaler on the resident's bed. Resident #69 confirmed that the they are permitted to keep the inhaler with them at all times. On 11/21/2022 at 11:57 AM, the surveyor interviewed Resident #69 regarding the inhaler usage. [...]

Inspectors wroteBased on observation, interview, record review, and review of other facility documentation, it was determined that the facility failed to develop a person-centered comprehensive care plan to address the use of Insulin for Diabetes (medication used to treat high blood sugar levels) for 1 of 5 Residents (Resident #102) reviewed for unnecessary medication. This deficient practice was evidenced by the following: On 11/17/2022 at 12:51 PM, Resident # 102 was observed in his/her room sitting in a chair and was non-verbal. A review of the admission Record revealed Resident # 102 was admitted to the facility with diagnoses including but not limited to; Diabetes Mellitus (a disease in which the body's ability to produce or respond to the hormone insulin is impaired). [...]

Inspectors wroteBased on observation, interview, review of the medical record and other facility documentation, it was determined that the facility failed to promote an accident free environment by not conducting quarterly smoking assessments. This deficient practice was identified for 1 of 1 resident reviewed for smoking, (Residents #50). This deficient practice was evidenced by the following: On 11/16/2022 at 12:27 PM, the surveyor observed Resident #50 sitting outside on the second floor balcony smoking area with staff nearby observing. On 11/17/2022 at 12:14 PM, the surveyor observed Resident #50 standing outside with cigarette. Resident independently extinguished cigarette and placed in proper receptacle. According to the admission Record, Resident # 50 was admitted to the facility with diagnoses which included but were not limited to; [...]

Inspectors wroteBased on observation, interview, record review and review of other facility documentation, it was determined that the facility failed to to ensure the catheter collection bag (bag that collects urine from a urinary drainage device) did not come into contact of the floor. The deficient practice was observed for 1 (Resident #7) of 2 residents reviewed for Catheters. This deficient practice was evidenced by the following: On 11/16/2022 at 9:50 AM during the initial tour of the facility, the surveyor observed Resident #7 in their wheelchair. Underneath the wheelchair was a urinary catheter drainage tube and drainage collection bag attached to the wheelchair. The drainage collection bag was in contact with the floor as Resident #7 propelled themselves in the wheelchair. On 11/17/2022 at 12:38 PM, during an interview with the surveyor, Resident #7 confirmed they had a urinary catheter. [...]

Inspectors wroteBased on interview and record review, it was determined that the facility failed to monitor antibiotic use for 1 of 2 residents (Resident #59) reviewed for antibiotic use and Antibiotic Stewardship. This deficient practice was evidenced by the following: According to the admission record, Resident #59 was admitted to the facility with diagnoses that included but were not limited to: mild cognitive impairment, iron deficiency anemia, major depressive disorder, vitamin deficiency, and Alzheimer's disease. A review of Resident #59's Order Summary Report revealed that Resident #59 had the following order: NITROFURANTOIN (an antibacterial medication used to treat urinary tract infections.) 50MG (milligrams) CAPS (capsule) Give 1 capsule orally in the evening every Tue, Thu, Sat related to CYSTITIS (inflammation of the urinary bladder. [...]

Inspectors wroteBased on interview and review of other facility documentation, it was determined that the facility failed to notify in writing the representative of the New Jersey Long-Term Care Ombudsman's office of emergency transfers to the hospital, when practicable, as mandated by Federal law. This deficient practice was evidenced by the following: During an interview with the surveyor on 11/28/2022 at 9:41 AM, the Director of admission when asked who is responsible for notifying the ombudsman of a facility-initiated emergency transfer to the hospital stated, not sure, I would think the social worker. During an interview with the surveyor on 11/28/2022 at 9:46 AM, the social worker when asked who is responsible for notifying the ombudsman of a facility-initiated emergency transfer to the hospital, stated, I'm not sure. I have to double check on that. [...]