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Complaint Investigation

St Mary's Center For Rehabilitation & Healthcare

November 21, 2025 · Cherry Hill, NJ · 220 St Mary's Drive
Citations 1
CMS Rating 3/5
Beds 215
Provider ID 315060
Healthcare Facility
St Mary's Center For Rehabilitation & Healthcare
Cherry Hill, NJ  ·  View full profile →
Source Document
Official CMS Inspection Report (Medicare.gov)
Downloaded from CMS/Medicare.gov. Reflects what state inspectors documented and does not include the facility's plan of correction, which is submitted separately. Facilities may have taken corrective actions since this report was released.
Inspection Summary

ST MARY'S CENTER FOR REHABILITATION & HEALTHCARE in CHERRY HILL, NJ — inspection on November 21, 2025.

Found 1 citation. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

Inspection Findings

FF0580
Resident Rights Deficiencies
Potential for More Than Minimal Harm

During the same interview the DON stated that providers may have been made aware that the medications were not administered, and the notifications were not documented.

The DON stated that it was her expectation that if a provider notification was made that a PN would be made to reflect the notification.

The DON further stated that a resident's medical record should reflect the care that was given and that failure to document provider notification was not in keeping with the facility's policy. An interview was conducted with NP #1 on 09/12/2025 at 1:20 P.M. NP #1 stated that she did not recall if she was notified of the aforementioned unadministered and refused medications for residents #1 and #3.

The surveyor attempted to reach the Medical Doctor (MD #2) for an interview on 09/16/2025 at 10:23 AM, and was informed that she was on leave of absence. An interview was conducted with the Medical Doctor (MD #1) on 09/19/2025 at 1:25 P.M. MD #1 stated that he did not recall if he was notified of unadministered phenobarbital doses for Resident #1. MD #1 further stated that facility staff made him aware of several times that Resident #3 did not receive Clinimax and Clinolipid but did not recall the dates.

The facility policy Change in Condition with an effective date of 12/2018 and a revised date of 02/2023, was reviewed.

Under Policy Interpretation and Implementation the policy revealed, The nurse will notify the resident's Attending Physician, or physician/NP of a change in condition if a concern warrants medical intervention. NJAC 8:39-13.1(d)

Facility ID:

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in CHERRY HILL, NJ, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from ST MARY'S CENTER FOR REHABILITATION & HEALTHCARE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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About This Inspection Report

Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.

Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.

Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.