Based on observations and staff interviews, the facility failed to properly contain trash in a closed dumpster resulting in trash overflowing the dumpster area, spilling onto the ground of 59 census residents. Findings include: During an observation on 02/26/24 at 9:00 AM, the dumpster area had trash overflowing onto the ground. At 11:10 AM, the dumpster area was observed to have primarily plastic wrappings, cardboard boxes, and pieces of boxes overflowing the dumpster with the lid opened. The Dietary Manager (DM) stated, trash will be picked up tomorrow. She said she would take care of the overflow. During an observation on 02/28/24 at 1:00 PM, the dumpster lid was closed, but there was still primarily discarded plastic refuse remaining that could potentiate pests in the area. During an observation on 02/29/24 at 7:30 AM, the dumpster area continued to have plastic wrappings and garbage outside the dumpster and the ground was littered with wet trash. During an interview on 02/29/24 at 9:20 AM, the Administrator was asked if there was a policy for trash disposal, and she said she didn't think there was a policy. She stated she had spoken with the DM and, .trash is picked up twice a week and we know it's required to keep it clean and contained in that area. She stated if there was a policy she would provide one. At 12:00 PM, she stated there was no specific policy, but they (facility) would take care of the trash situation. NJAC 8:39-19.3(c) NJAC 8:39-19.7(a)(b)

Complaint #: NJ00165860 Based on observation, interviews, medical record review, and review of other pertinent facility documents on 7/31/23 and 8/1/23, it was determined that the facility failed to ensure that the staff had checked and documented the temperature daily on the refrigerator located in the [NAME] Unit pantry first floor and that staff had labeled and dated the residents' food items for storage in the fridge for 1 of 2 units. The facility also failed to follow its policies titled Foods Brought by Family/Visitors and Food Storage Procedure. This deficient practice is evidenced by the following: During the tour of the first floor, [NAME] unit on 7/31/23 at 11:48 a.m, in the presence of the Unit Clerk (UC), the surveyor observed that the refrigerator located on the first-floor west unit pantry did not have temperatures documented on the REFRIGERATOR TEMPERATURE LOG (RTL) for the month of 7/2023 from 7/25/23 to 7/30/23. A total of 6 days. In addition, 1 container dated 7/21/23, 1 container of pineapple and 1 container of soup with no labels, and grapes in plastic with no labels. According to the UC, the refrigerator was used to store food items for residents in the [NAME] Unit. The surveyor further observed a form was attached to the refrigerator indicating, ATTENTION ALL VISITORS AND STAFF ALL FOOD OR DRINKS PLACED IN THE FRIDGE MUST BE LABELED WITH NAME AND DATE. ALL ITEMS WILL BE DISCARDED AFTER 3 DAYS. ANY ITEMS NOT LABELED WILL BE DISCARDED. THANKS MANAGEMENT. During an interview with the Director of Nursing (DON) on 7/31/23 at 3:41 p.m., in the presence of Licensed Nursing Home Administrator (LNHA) and Regional LNHA (RLNHA), she stated that it was the housekeeping department's job to ensure that the refrigerator was clean daily and foods that were more than 3 days were to be discarded. During an interview with the Director of Environment on 8/1/23 at 9:00 a.m., he stated that the housekeeping department was responsible for deep cleaning the [NAME] Unit refrigerator every first and fifteenth of each month. During a second interview on 8/1/23 at 9:33 a.m., the DON stated that it was the Unit Manager's responsibility to check the refrigerator temperature and to make sure that there was resident's food was not expired or to be discarded after 3 days of the label. The DON confirmed that the resident's food items should be labeled and dated. She stated that foods not labeled/dated should be thrown away. During an interview with the Unit Manager (UM) on 8/31/23 at 10:00 a.m., she stated that food items from the community must be labeled with the resident's name and dated prior to storing them in the pantry refrigerator. The UM revealed that she could not tell if the refrigerator had been checked on the aforementioned dates because she was off. A review of the facility's policy titled, Foods Brought by Family/Visitors, reviewed on 5/18/23, included the following: .5. Containers will be labeled with the resident's name, the item and the 'use by' date. 6. The nursing staff is responsible for discarding perishable foods on or before the 'use by' date. 7. The nursing and/or food service staff must discard any foods prepared for the resident that show obvious signs of potential foodborne danger, for example, mold growth, foul odor, past due package expiration dates) . A review of the facility's policy titled, [Facility Name] Food Storage Procedure undated, revealed the following: .All foods stored in the refrigerator or freezer will be covered, labeled and dated. 6. Refrigerated foods must be stored at or below 40 F [Fahrenheit] unless otherwise specified by law. 7. Functioning of the refrigeration and food temperatures will be monitored at designated intervals and documented according to state-specific requirements . NJAC 8:39-17.2 (g)

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Complaint #: NJ00165860 Based on interviews, medical record review, and review of other pertinent facility documents on 7/31/23 and 8/1/23, it was determined that the facility failed to consistently document in the Documentation Survey Report (DSR) Activities of Daily Living (ADL) care as being provided to Resident #1, Resident #2, and Resident #3 reviewed for documentation. The facility also failed to follow its policy titled Activities of Daily Living (ADLs) and the Certified Nursing Aide job description. This deficient practice was identified for 3 of 3 residents and was evidenced by the following: 1. According to the facility admission Record (AR), Resident #1 was admitted on [DATE] with a diagnosis that included but ware not limited to Dementia with other Behavioral Disturbances and Muscle Weakness. The Minimum Data Set (MDS), an assessment tool, dated 6/8/23, revealed a Brief Interview of Mental Status (BIMS) of 01, which indicated the Resident's cognition was severely impaired and the Resident needed assistance with activities of daily living (ADLs) including toileting, eating, and bed mobility. A Care Plan (CP), initiated on 3/10/23 and revised on 7/18/23, included that the Resident was totally dependent on staff for all ADL needs. Review of Resident #1's DSR (ADL Record) and the progress notes (PN) for the month of 6/2023 and 7/2023 showed no documented evidence that the tasks were completed for eating, bed mobility, and toileting were provided and/or the Resident refused care on the following dates and shifts: On the 7:00 a.m. - 3:00 p.m. shift on 6/2/23 to 6/4/23, 6/6/23, 6/9/23, 6/13/23, 6/14/23, 6/17/23, 6/19/23, 6/20/23, 6/22/23, 6/23/23, 6/25/23, 7/1/23 to 7/4/23, 7/6/23, 7/7/23, 7/10/23 to 7/12/23, 7/14/23 to 7/18/23, 7/20/23, 7/21/23, 7/24/23, 7/26/23, and 7/28/23 to 7/30/23. On the 3:00 p.m. - 11:00 p.m. shift on 6/8/23 to 6/11/23, 6/15/23 to 6/24/23, 7/1/23 to 7/5/23, 7/9/23 to 7/19/23, 7/21/23 to 7/23/23, and 7/25/23 to 7/30/23. On the 11:00 p.m. -7:00 a.m. shift on 6/4/23, 6/13/23, 6/18/23, 6/21/23 to 6/23/23, 6/27/23, 7/14/23, 7/16/23, 7/17/23, and 7/30/23, except for eating. 2. According to the facility AR, Resident #2 was admitted on [DATE] with diagnoses that included but were not limited to Difficulty Walking and Muscle Weakness. The MDS, dated [DATE], revealed a BIMS of 11, indicating that the Resident's cognition was moderately impaired and needed assistance with ADLs. The CP initiated on 7/11/23 included that Resident #2 had an ADL self-care performance deficit. A review of Resident #2's DSR and PN for the month of 7/2023 had no documented evidence that the ADL tasks were completed and/or the Resident refused to care for toileting, bed mobility, and eating on the following dates and shifts: On the 7:00 a.m. - 3:00 p.m. shift on 7/11/23, 7/12/23, 7/14/23 to 7/18/23, 7/20/23, 7/21/23, 7/24/23, 7/26/23, and 7/30/23. On the 3:00 p.m. - 11:00 p.m. shift on 7/11/23 to 7/19/23, 7/21/23, 7/23/23 to 7/25/23, and 7/27/23 to 7/30/23. On the 11:00 p.m. - 7:00 a.m. shift on 7/14/23, 7/16/23, 7/17/23, 7/20/23, and 7/30/23, except for eating. 3. According to the facility AR, Resident #3 was admitted on [DATE] with a diagnosis that included but was not limited to: Alzheimer's Disease and Weakness. The MDS, dated [DATE], revealed a BIMS of 1, which indicated that the Resident's cognition was severely impaired and needed assistance with ADLs. The CP initiated on 1/27/22 and revised on 5/24/23 included that Resident # was incontinent of bowel and required maximum assistance with dining. A review of Resident #2's DSR and PN for the month of 6/2023 and 7/2023 showed no documented evidence that the tasks were completed, and care was provided and/or the Resident refused care for bed mobility, eating, and toileting on the following dates and shifts: On the 7:00 a.m. - 3:00 p.m. shift on 6/3/23, 6/5/23, 6/7/23, 6/19/23, 7/14/23, 7/15/23, 7/25/23, 7/27/23, and 7/30/23. On the 3:00 p.m. - 11:00 p.m. shift on 6/2/23, 6/17/23, 6/18/23, and 6/30/23. On the 11:00 p.m. - 7:00 a.m. shift on 6/5/23, 6/13/23, 6/18/23, 6/21/23 to 6/23/23, 6/27/23, 7/16/23, 7/17/23, 7/23/23, and 7/30/23. During an interview with the surveyor on 8/1/23 at 1:57 p.m., Certified Nursing Assistant (CNA #1), who took care of Resident #1 during 7:00 a.m. to 3:00 p.m. shift, stated that CNAs are responsible for documenting the ADL care provided into the Point of Care (is a mobile-enabled app that runs on wall-mounted kiosks or mobile devices that enables care staff to document activities of daily living at or near the point of care to help improve accuracy and timeliness of documentation). CNA #1 further stated that he would document even if the care was not provided due to refusal. He explained that the documentation must be completed in the Resident's DSR by the end of each shift to show that the care was provided to the residents. CNA #1 could not explain why there were blanks in the sampled Resident's DSR but stated that it [the DSR] should have been completed [signed]. During an interview with the surveyor on 8/1/23 at 10:00 a.m., the Licensed Practical Nurse (LPN #1) stated that the CNAs were expected to document the ADLs care provided to the Resident by the end of the shift in the DSR. She explained that the Unit Managers (UM) were to check the documentation to ensure the DSR was completed at the end of the shift. LPN #1 could not explain why there were blanks in Resident #1's, Resident #2's, and Resident #3's DSR but stated that they should have been completed to show that the care was provided or if the Resident refused care from the CNAs. Review of the job description titled Certified Nursing Aide (CNA), indicated under DOCUMENTS THE FOLLOWING .8. ADL tracker . Review of a facility policy titled Activities of Daily Living (ADLs), dated 7/1/21, reflected PRACTICE STANDARDS .5. ADL care is documented every shift by the nursing assistant . NJAC 8:39-35.2(d)(9)

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Complaint #: NJ00165860 Based on observation, interviews, and record review, as well as review of pertinent facility documents on 7/31/23 and 8/1/23, it was determined that the facility failed to ensure infection control practice was implemented for a resident (Resident #3) observed during wound care treatment. The facility also failed to follow its policy titled Handwashing/Hand Hygiene. This deficient practice was identified for 1of 2 residents and was evidenced by the following: According to the CDC, Morbidity, and Mortality Weekly Report (MMWR) Guideline for Hand Hygiene in Health-Care Settings, dated October 25, 2002, under Recommendations: 1. Indications for handwashing and hand antisepsis .G. Decontaminate hands after contact with body fluids or excretions, mucous membranes, nonintact skin, and wound dressings if hands are not visibly soiled. H. Decontaminate hands if moving from a contaminated-body site to a clean-body site during patient care, if gloves became visibly soiled with blood or body fluids following a task . According to the Centers for Disease Control (CDC) and Prevention titled Hand Hygiene in Healthcare Settings, reviewed on 1/8/21, under Techniques for Washing Hands with Soap and Water .When cleaning your hands with soap and water, wet your hands first with water, apply the amount of product recommended by the manufacturer to your hands, and rub your hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers .Gloves Use When and How to Wear Gloves .Change gloves and perform hand hygiene during patient care, if gloves become damaged, gloves become visibly soiled with blood or body fluids following a task, moving from work on a soiled body site to a clean body site on the same patient .Carefully remove gloves to prevent hand contamination. According to the admission Record, Resident #3 was initially admitted to the facility on [DATE] with diagnoses that included but were not limited to Dementia and Urinary Tract Infection. The Care Plan (CP) was initiated on 1/27/23 and revised on 5/24/23. The CP indicated that Resident #3 was at risk for skin integrity. The Associates in Vascular Care Wound Care Assessment, dated 7/25/23, showed that Resident #3 had a stage 4 pressure wound to the Sacrum area measuring 3.5 centimeters (cm) x 3.2 cm x 4 cm, undermining 3.0 cm at 6 - 12 o'clock. The Order Summary Report, dated 7/13/23, showed an order for Dakin's External Solution to apply to Sacrum topically one time a day for Pressure Wound Unstageable, pack 1/4 of wound with Dakin's with saturated gauze and cover. The Treatment Administration Record (TAR) dated 7/2023 indicated the aforementioned order, and the treatment was provided by the Licensed Practical Nurse (LPN #1) on 7/31/23. On 7/31/23 at 10:36 a.m. and 10:26 a.m., the surveyor observed LPN #1 performed wound care to Resident #3. LPN #1 walked into the Resident's room with treatment supplies in his hand and placed them on top of the Resident's bedside table. LPN #1 donned clean gloves, grabbed the gauze in a cup with Dakin's solution, and cleaned the Resident's wound on the sacral area. LPN #1, with the same gloves on, packed the wound bed with gauze saturated with Dakin's solution, doffed the dirty gloves, donned a new set of gloves, then covered the sacral wound with 4 x 4 border gauze. LPN #1 removed the gloves, performed hand washing, and rubbed the hands with soap under running water for 12 seconds. LPN #1 then proceeded to perform wound care on the Resident's left lateral heel (LLH). LPN #1 then washed his hands after completing wound care to the LLH for 13 seconds. The facility's Infection Control Preventionist (ICP) was unavailable for an interview during the survey on 7/31/23. The surveyor conducted an interview with LPN #1 on 8/1/23 at 2:45 p.m, he stated that she should have wash hands for 20 seconds and change gloves after cleansing Resident #3's sacral area with Dakin's solution because it was dirty and to prevent contamination. During the surveyor's interview with the Director of Nursing (DON) on 7/31/23 at 3:41 p.m., with the presence of the Administrator and Regional Administrator, the DON stated that gloves should be removed and washing hands for at least 20 seconds after touching dirty/soiled material, after cleansing the wound, then don clean gloves before applying a new dressing onto the wound to prevent infection. The sample Hand Hygiene Competency Validation, dated 3/15/23, indicated .4. Vigorously rubs hands for at least 20 seconds including palms, back of hands, between fingers, and wrists . Review of LPN #1's Skills Checklist: Wound Care, dated 3/22/23, indicated, .Remove current dressing they expose wound remove packing from wound assess warned appearance and appearance of any drainage on the dressing and packing we remove gloves and perform hand hygiene .Prepare supplies for cleaning and dressing wound .don sterile gloves Clean wound working from cleanest to dirtiest . A review of the facility's inservice for proper hand washing, dated 5/1/23, attached to the inservice was the policy for Handwashing/Hand Hygiene, indicated .The facility considers hand hygiene the primary means to prevent the spread of infections. 2. All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors .4. Employees must wash their hands for at least twenty (20) seconds using antimicrobial or non-antimicrobial soap and water .Procedure Washing Hands .2. Vigorously lather hands with soap and rub them together, creating friction to all surfaces, for at least twenty (20) seconds, then raise hands under a moderate stream of running water at a comfortable temperature . The facility's policy titled Handwashing/Hand Hygiene updated, undated, indicated Protocol Statement This facility considers hand hygiene the primary means to prevent the spread of infection .2. All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors .4. Employees must wash their hands for at least twenty (20) seconds using antimicrobial or non-antimicrobial soap and water .Procedure Washing Hands .2. Vigorously lather hands with soap and rub them together, creating friction to all surfaces, for at least twenty (20) seconds, then raise hands under a moderate stream of running water at a comfortable temperature . NJAC 8:39-19.4(a)