Runnells Center For Rehabilitation & Healthcare

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

for the anticoagulant, the right arm bruise and dementia.On 10/31/25 at 11:59 PM, during an interview with

the surveyors, the Assistant Director of Nursing (ADON) confirmed that a reportable was not filed with the NJDOH when a unilateral bruise on the right eye and the right arm was found, that was investigated in the facility as a bruise of unknown origin. The ADON stated that the unilateral bruises found on the resident was caused by the aspirin. At that time, the surveyor and the ADON reviewed the CP together. The ADON confirmed the Aspirin, should have been care planned.On 10/31/25 at 12:50 PM, in the presence of a surveyor, the Assistant Administrator (AIT), the ADON, the Regional DON, and the assisting Administrator of the Behavioral Health (LNHA), the surveyor discussed the concerns with not reporting the injury of unknown source and the individualized care plan that was not thoroughly updated to include, Aspirin, the right arm bruise and for diagnosis of dementia and its associated interventions.No further information was provided.A review of the facility provided policy for Accident and Incident - Investigation A review of the facility provided policy for Interdisciplinary Care Planning Policy and Procedure dated 8/1/25 included that individualized interdisciplinary [ID] interventions will be planned by each discipline to correct problems identified during IDCP conference. NJAC 8:39-4.1(a)(5)

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

10/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Runnells Center for Rehabilitation & Healthcare

40 Watchung Way Berkeley Heights, NJ 07922

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

Mental Status (BIMS) score of 00 out of 15, which indicated the resident had a severely impaired cognition.

The resident had no indicators of psychosis. Section GG, Functional Abilities reflected the resident was dependent on a helper for mobility that included: rolling left to right, sit to lying, for transfers from chair to bed, toileting and showering.A review of the individualized comprehensive care plan (CP) included a focus that Resident #3 was high risk for falls, initiated on 6/3/25. The interventions included to offer toileting to the resident prior to bed and rounding at least every two (2) hours at night, initiated on 6/20/25.A review of Resident #3's POCS from 06/01/25 to 06/30/25, reflected the following: -There were 21 out of 90 shifts, charting blanks for bowel and bladder elimination monitoring. - There were 22 out of 90 shifts, that reflected charting blanks for behavior monitoring that included wandering.On 10/31/25 at 11:50 AM, in the presence of two surveyors, the Assistant Director of Nursing (ADON) stated that they did not document anywhere the 2-hour monitoring for Resident #1 and the 2-hour monitoring at night, for Resident #3 as it was their standard of practice to often see their residents. The ADON could not provide evidence that this individualized care plan intervention was implemented. At that time, the ADON acknowledged and confirmed the CPs should be individualized. On 10/31/25 at 12:50 PM, in the presence of a surveyor, the Assistant Administrator (AIT), the ADON, the Regional DON, and the assisting Administrator of the Behavioral Health (LNHA), the surveyor discussed the concerns with the charting blanks on the POCs and

the missing documentation to show that both resident's were monitored every 2-hours as part of the CP intervention.No further information was provided.A review of the facility provided policy, titled, Nursing Documentation, dated/revised 5/5/25, included to document all pertinent psychosocial, medical and nursing

observations. The plan of care and response must be included. NJAC 8:39-27.1 (a)

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

10/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Runnells Center for Rehabilitation & Healthcare

40 Watchung Way Berkeley Heights, NJ 07922

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

focus area for nutrition, initiated on 3/21/25. The interventions included to monitor oral intake as needed that was also initiated on 3/21/25.A review of the Documentation Survey Report (the report of the electronic point-of-care system (POCS) where the Certified Nursing Assistants (CNAs) electronically document patient care activities). The POCS revealed the following:-during the resident's stay on July 2025, 16 of the 62 shifts the CNAs documented the percentage of meal that was eaten by the resident. There were 46 charting blanks.-during the resident's stay on August 2025, 6 of the 62 shifts the CNAs documented the percentage of meal that was eaten by the resident. There were 56 charting blanks.On 10/28/25 at 4:14 PM,

in the presence of a surveyor, the Assistant Administrator (AIT), the ADON, the Regional DON, and the assisting Administrator of the Behavioral Health (LNHA), the surveyor discussed the concern that the evidence of a re-weight was not present in the medical record to ensure the weigh variance was investigated prior to interventions were made and the concern with the monitoring of the resident's consumption as indicated within the care plan.A review of the provided Dietary Intake policy dated 8/1/25, reflected that dietary intake would be monitored by the CNA assigned to a particular resident for breakfast, lunch and supper. A review of the provided Weights policy, dated 8/1/25, reflected that the licensed nurse will evaluate all weights obtained . and determine if re-weight is necessary. The licensed nurse will be responsible for transcribing the weight in the re-weight box on the weight record. NJAC 8:39-27.1(a),27.2(a)

Event ID:

Facility ID:

If continuation sheet