Jersey Shore Skilled Nursing: Infection Control Failure - PA
Federal inspectors cited Jersey Shore Skilled Nursing and Rehabilitation Center in August 2025 for failing to implement evidence-based infection control practices for a recently admitted resident who had indwelling nephrostomy tubes, devices that drain urine directly from the kidneys and carry significant infection risk when not properly managed.
The resident, identified in inspection records only as Resident 1, was a recent admission to the facility. Inspectors found no evidence-based practices, known in clinical settings as EBP, had been put in place for that resident's care.
What made the finding harder to dismiss was the source of the standard. It wasn't an outside expert or a federal guideline that inspectors had to explain to facility leadership. It was the facility's own infection preventionist, the staff member whose job is specifically to prevent exactly this kind of lapse, who told inspectors that a resident with indwelling nephrostomy tubes should have those practices in place.
The facility's infection preventionist confirmed to inspectors that evidence-based protocols were warranted for a patient in Resident 1's situation. The protocols were not there.
Inspectors raised the findings directly with the facility's top leadership. On August 14, 2025, at 3:30 in the afternoon, the surveyor reviewed the concerns with the Nursing Home Administrator and the Director of Nursing together. Both were present. Both heard what inspectors had found.
The citation fell under the federal infection control regulation, 42 CFR 483.80, which governs how nursing homes are required to establish and maintain infection prevention programs. Inspectors classified the level of harm as minimal harm or potential for actual harm, and noted that some residents were affected.
It was not the first time.
The same infection control deficiency had been cited at Jersey Shore Skilled Nursing just three months earlier, on May 16, 2025. That prior citation appears in the inspection record alongside the August finding, flagged as a previously cited deficiency. A violation that appears once can be a gap. The same violation appearing again, at the same facility, under the same regulatory tag, three months later, is a pattern.
Nephrostomy tubes are not minor medical equipment. They are inserted through the skin and directly into the kidney to drain urine when normal urinary pathways are blocked or damaged. Because they create a direct external pathway into an internal organ, they are a known and serious infection risk. Patients with these devices require careful, consistent infection prevention protocols. The absence of those protocols is not a paperwork problem. It is a clinical one.
The inspection was conducted as a complaint survey, meaning someone, whether a resident, a family member, or a staff member, contacted regulators with a concern serious enough to prompt an on-site investigation. The record does not identify who filed the complaint or what specifically triggered it.
What the record does show is that when inspectors arrived, they found a recently admitted resident with a high-risk medical device and no evidence-based infection control plan to protect them. They found a facility infection preventionist who knew such a plan was needed. And they found that three months after the last time regulators flagged this exact problem, the facility had not fixed it.
The Nursing Home Administrator and the Director of Nursing were informed of all of this at 3:30 on a Thursday afternoon in August.
Resident 1 had already been in the facility for some period of time without those protections in place.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Jersey Shore Skilled Nursing and Rehabilitation Ce from 2025-08-14 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
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Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: October 19, 2026 · Our methodology
JERSEY SHORE SKILLED NURSING AND REHABILITATION CE in JERSEY SHORE, PA was cited for violations during a health inspection on August 14, 2025.
The resident, identified in inspection records only as Resident 1, was a recent admission to the facility.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.